False-Positive Radioiodine Scans in Thyroid Cancer

Shapiro, Brahm; Rufini, Vittoria; Jarwan, Ayman; Geatti, Onelio; Kearfott, Kimberlee J.; Fig, Lorraine M.; Kirkwood, Ian; Freitas, John E.; Gross, Milton D.

doi:10.1007/978-1-59259-995-0_16

Cited by 3 publications

(1 citation statement)

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“…A gland exhibiting inherently higher retention is exposed to more radiation from a 131 I-treatment, which can consequently cause narrowing or obstruction in its duct and sialadenitis. 4 , 20 , 21 , 22 This can lead to increased retention/lowered excretion in a subsequent 131 I-treatment, causing more extensive radiation damage. This cumulative effect could result in some glands losing complete function after multiple 131 I-treatments, while other glands may be unaffected, possibly explaining the intrapatient and interpatient variation exhibited by these 5 patients.…”

Section: Discussionmentioning

confidence: 99%

PSMA PET/CT Identifies Intrapatient Variation in Salivary Gland Toxicity From Iodine-131 Therapy

et al. 2020

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Introduction: Xerostomia is a well-known complication after iodine-131 (131I) therapy for thyroid carcinoma. It is currently insufficiently understood how the dose and biodistribution of 131I relates to salivary gland toxicity, and whether this is consistent for all salivary glands within a single patient. Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) was recently introduced as a new tool to evaluate the relative loss of vital acinar cells in individual salivary glands. We aimed to assess gland-specific salivary gland toxicity after 131I-therapy using PSMA PET/CT. Methods: Five patients with differentiated thyroid cancer underwent [68Ga]Ga-PSMA-11 PET/CT to evaluate their eligibility for peptide radioligand therapy with [177Lu]Lu-PSMA-617. Uptake patterns in salivary glands were evaluated visually and quantitatively as an indicator of vital acinar cell loss after prior 131I-therapy. Results: Four of 5 patients demonstrated significant lowered uptake in at least one salivary gland, after receiving at least 2 131I-treatments. Asymmetric loss of vital acinar cells occurred by gland type (parotid/submandibular) and location (right/left). The other salivary glands in these patients and all salivary glands in the fifth patient showed normal uptake, demonstrating high intrapatient and interpatient variability. Conclusions: 131I-therapy can induce salivary gland toxicity with high inter- but also high intrapatient variation among separate gland locations, which can be assessed with PSMA PET/CT. This new technique offers potential to guide further development and evaluation of protective measures in patients receiving 131I-therapy.

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Section: Discussionmentioning

confidence: 99%

PSMA PET/CT Identifies Intrapatient Variation in Salivary Gland Toxicity From Iodine-131 Therapy

et al. 2020

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Radioiodine retention on percutaneous endoscopic gastrostomy tubes

Scuffham¹,

Wood²,

Clauss³

et al. 2012

BJR

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An 80-year-old male with recurrent thyroid cancer and a percutaneous endoscopic gastrostomy (PEG) tube in situ was referred for radioiodine therapy and was administered 5510 MBq I-131 sodium iodide intravenously. Sequential whole-body images taken over the subsequent 7 days for dosimetric evaluation revealed an area of persistent high uptake in the abdomen. Delayed imaging with single photon emission CT/CT at 15 days post administration revealed this uptake to be at the junction of the PEG tube with the anatomically normal stomach wall. We hypothesise that the PEG tube became contaminated by radioiodine secreted in the gastric mucosa during therapy and this radioactivity subsequently decayed with an increased effective half-life relative to the stomach, leading to the apparent hot spot.

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Thymus uptake of131I in patients with differentiated thyroid carcinoma

Abhyankar

Basu

2015

Journal of Cancer Research and Therapeutics

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The importance of recognizing thymic radioiodine uptake as the cause of a false-positive mediastinal focus in the whole-body 131I scan, done for the evaluation of post-thyroidectomy cases of differentiated thyroid carcinoma, is illustrated with the corresponding clinicoradiorological correlation. The pattern of mediastinal uptake could vary based upon the pattern of thymic hyperplasia in an individual case. Three different patterns of mediastinal uptake were observed in the cases described in the present report. Recognizing the patterns and the clinical settings (where this was to be suspected by the treating physician) was important to obviate unnecessary aggressive treatment, such as, surgery or radioiodine therapy. In a review of the literature, we found that a majority of the cases were reported in the young population (related to the thymus reaching its peak size during adolescence and gradual atrophy in the following decades) and in patients undergoing a six-month follow-up whole body diagnostic scan after thyroid remnant ablation treatment, and also in patients receiving a second course of 131-iodine treatment for a persistently elevated thyroglobulin (Tg) level. The indicators that should raise the suspicion of false-positive radioiodine uptake to the attending physician include: (a) undetectable/low serum thyroglobulin level (although this may not be always the case, depending on the clinical setting), (b) a well-controlled disease with no other abnormal focus in the rest of the body,

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False-Positive Radioiodine Scans in Thyroid Cancer

Cited by 3 publications

References 132 publications

PSMA PET/CT Identifies Intrapatient Variation in Salivary Gland Toxicity From Iodine-131 Therapy

PSMA PET/CT Identifies Intrapatient Variation in Salivary Gland Toxicity From Iodine-131 Therapy

Radioiodine retention on percutaneous endoscopic gastrostomy tubes

Thymus uptake of131I in patients with differentiated thyroid carcinoma

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