Skip to main content

Advertisement

Log in

Five months’ follow-up of patients with and without iodine-positive lymph node metastases of thyroid carcinoma as disclosed by 131I-SPECT/CT at the first radioablation

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

In differentiated thyroid carcinoma (DTC), 131I-SPECT/CT is more accurate in identifying radioiodine-positive lymph node metastases (LNM) than planar whole-body scans (WBS). The purpose of this study was to investigate the value of 131I-SPECT/CT performed at the first radioablation to predict the occurrence and/or persistence of cervical radioiodine-positive LNM 5 months later.

Methods

The study included 81 DTC patients that had had SPECT/ spiral CT after radioablation of thyroid remnants after thyroidectomy. The patients were re-examined 5 months later using 131I-WBS performed at TSH stimulation. In addition, SPECT/CT of the neck was performed in patients with iodine-positive cervical foci to distinguish between thyroid remnant and LNM. The outcome variable of the study was the detection or exclusion of iodine-positive cervical LNM.

Results

Of 61 patients without a SPECT/CT diagnosis of 131I-positive LNM at radioablation, 60 had no 131I-positive LNM at follow-up. In the remaining patient of this group, a new radioiodine-positive LNM was detected. In 17 of 20 patients with a SPECT/CT diagnosis of 131I-positive LNM (n = 19) or an indeterminate lesion (n = 1) at first radioablation, no 131I-positive LNM were detected 5 months later. Radioiodine-positive LNM persisted in three patients of this group.

Conclusion

131I-SPECT/CT has a high negative predictive value with regard to the occurrence of radioiodine-positive cervical LNM 5 months after initial therapy. The majority of iodine-positive LNM diagnosed by SPECT/CT at radioablation disappear within 5 months. These findings motivate further research into the value of 131I-SPECT/CT of the neck for predicting recurrence and planning surgical reintervention in DTC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Seidlin SM, Marinelli LD, Oshry E. Radioactive iodine therapy: effect on functioning metastases of adenocarcinoma of the thyroid. JAMA 1946;132:838–47.

    CAS  Google Scholar 

  2. Carlisle MR, Lu C, McDougall IR. The interpretation of 131I scans in the evaluation of thyroid cancer, with an emphasis on false positive findings. Nucl Med Commun 2003;24:715–35.

    Article  CAS  PubMed  Google Scholar 

  3. Seo Y, Mari C, Hasegawa BH. Technological development and advances in single-photon emission computed tomography/computed tomography. Semin Nucl Med 2008;38:177–98.

    Article  PubMed  Google Scholar 

  4. Bockisch A, Freudenberg LS, Schmidt D, Kuwert T. Hybrid imaging by SPECT/CT and PET/CT: proven outcomes in cancer imaging. Semin Nucl Med 2009;39:276–89.

    Article  PubMed  Google Scholar 

  5. Tharp K, Israel O, Hausmann J, Bettman L, Martin WH, Daitzchman M, et al. Impact of 131I-SPECT/CT images obtained with an integrated system in the follow-up of patients with thyroid carcinoma. Eur J Nucl Med Mol Imaging 2004;31:1435–42.

    Article  CAS  PubMed  Google Scholar 

  6. Ruf J, Lehmkuhl L, Bertram H, Sandrock D, Amthauer H, Humplik B, et al. Impact of SPECT and integrated low-dose CT after radioiodine therapy on the management of patients with thyroid carcinoma. Nucl Med Commun 2004;25:1177–82.

    Article  PubMed  Google Scholar 

  7. Chen L, Luo Q, Shen Y, Yu Y, Yuan Z, Lu H, et al. Incremental value of 131I SPECT/CT in the management of patients with differentiated thyroid carcinoma. J Nucl Med 2008;49:1952–7.

    Article  PubMed  Google Scholar 

  8. Wong KK, Zarzhevsky N, Cahill JM, Frey KA, Avram AM. Incremental value of diagnostic 131I SPECT/CT fusion imaging in the evaluation of differentiated thyroid carcinoma. AJR Am J Roentgenol 2008;191:1785–94.

    Article  PubMed  Google Scholar 

  9. Kohlfuerst S, Igerc I, Lobnig M, Gallowitsch HJ, Gomez-Segovia I, Matschnig S, et al. Posttherapeutic (131)I SPECT-CT offers high diagnostic accuracy when the findings on conventional planar imaging are inconclusive and allows a tailored patient treatment regimen. Eur J Nucl Med Mol Imaging 2009;36:886–93.

    Article  CAS  PubMed  Google Scholar 

  10. Spanu A, Solinas ME, Chessa F, Sanna D, Nuvoli S, Madeddu G. 131I SPECT/CT in the follow-up of differentiated thyroid carcinoma: incremental value versus planar imaging. J Nucl Med 2009;50:184–90.

    Article  PubMed  Google Scholar 

  11. Schmidt D, Szikszai A, Linke R, Bautz W, Kuwert T. Impact of 131I SPECT/spiral CT on nodal staging of differentiated thyroid carcinoma at the first radioablation. J Nucl Med 2009;50:18–23.

    Article  PubMed  Google Scholar 

  12. Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JWA, Wiersinga W, et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 2006;154:787–803.

    Article  CAS  PubMed  Google Scholar 

  13. Greene FL, Page DL, Fleming ID, Fritz A, Balch CM. AJCC cancer staging handbook. New York: Springer; 2002.

    Book  Google Scholar 

  14. Sawka AM, Thephamongkhol K, Brouwers M, Thabane L, Browman G, Gerstein HC. Clinical review 170: a systematic review and metaanalysis of the effectiveness of radioactive iodine remnant ablation for well-differentiated thyroid cancer. J Clin Endocrinol Metab 2004;89:3668–76.

    Article  CAS  PubMed  Google Scholar 

  15. Sawka AM, Brierley JD, Tsang RW, Thabane L, Rotstein L, Gafni A, et al. An updated systematic review and commentary examining the effectiveness of radioactive iodine remnant ablation in well-differentiated thyroid cancer. Endocrinol Metab Clin North Am 2008;37:457–80.

    Article  PubMed  Google Scholar 

  16. Handkiewicz-Junak D, Wloch J, Roskosz J, Krajewska J, Kropinska A, Pomorski L, et al. Total thyroidectomy and adjuvant radioiodine treatment independently decrease locoregional recurrence risk in childhood and adolescent differentiated thyroid cancer. J Nucl Med 2007;48:879–88.

    Article  CAS  PubMed  Google Scholar 

  17. Mazzaferri EL, Kloos RT. Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab 2001;86:1447–63.

    Article  CAS  PubMed  Google Scholar 

  18. Hay ID, McDougall IR, Sisson JC. A proposition for the use of radioiodine in WDTC management. J Nucl Med 2009;50:329–30.

    Article  Google Scholar 

  19. Verburg FA, Dietlein M, Lassmann M, Luster M, Reiners C. Why radioiodine remnant ablation is right for most patients with differentiated thyroid carcinoma. Eur J Nucl Med Mol Imaging 2009;36:343–6.

    Article  PubMed  Google Scholar 

  20. Bonnet S, Hartl D, Leboulleux S, Baudin E, Lumbroso JD, Al Ghuzlan A, et al. Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm: implications for radioiodine treatment. J Clin Endocrinol Metab 2009;94:1162–7.

    Article  CAS  PubMed  Google Scholar 

  21. Ali N, Sebastian C, Foley RR, Murray I, Canizales AL, Jenkins PJ, et al. The management of differentiated thyroid cancer using 123I for imaging to assess the need for 131I therapy. Nucl Med Commun 2006;27:165–9.

    Article  PubMed  Google Scholar 

  22. Gemsenjäger E, Perren A, Seifert B, Schüler G, Schweizer I, Heitz PU. Lymph node surgery in papillary thyroid carcinoma. J Am Coll Surg 2003;197:182–90.

    Article  PubMed  Google Scholar 

  23. Shindo M, Wu JC, Park EE, Tanzella F. The importance of central compartment elective lymph node excision in the staging and treatment of papillary thyroid cancer. Arch Otolaryngol Head Neck Surg 2006;132:650–4.

    Article  PubMed  Google Scholar 

  24. Machens A, Holzhausen HJ, Dralle H. Skip metastases in thyroid cancer leaping the central lymph node compartment. Arch Surg 2004;139:43–5.

    Article  PubMed  Google Scholar 

  25. Durante C, Haddy N, Baudin E, Leboulleux S, Hartl D, Travagli JP, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin Endocrinol Metab 2006;91:2892–9.

    Article  CAS  PubMed  Google Scholar 

  26. Zanotti-Fregonara P, Grassetto G, Hindié E, Rubello D. A low thyroglobulin level cannot be used to avoid adjuvant 131I therapy after thyroidectomy for thyroid carcinoma. Eur J Nucl Med Mol Imaging 2009;36:169–71.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The SPECT/CT camera Symbia T2 which was used to examine 23 of the 57 patients was kindly provided by Siemens Medical Solutions, Erlangen, Germany. The authors gratefully acknowledge the technical support by Ms. Anja Reimann and the language review provided by Dr. Hans Vija. This study would not have been possible without the generous support and constant advice of the late Prof. Werner Bautz.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Daniela Schmidt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schmidt, D., Linke, R., Uder, M. et al. Five months’ follow-up of patients with and without iodine-positive lymph node metastases of thyroid carcinoma as disclosed by 131I-SPECT/CT at the first radioablation. Eur J Nucl Med Mol Imaging 37, 699–705 (2010). https://doi.org/10.1007/s00259-009-1299-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-009-1299-2

Keywords

Navigation