Possible delayed diagnosis and treatment of metastatic differentiated thyroid cancer by adopting the 2015 ATA guidelines

Albano, Domenico; Bertagna, Francesco; Bonacina, Mattia; Durmo, Rexhep; Cerudelli, Elisabetta; Gazzilli, Maria; Panarotto, Maria Beatrice; Formenti, Anna Maria; Mazziotti, Gherardo; Giustina, Andrea; Giubbini, Raffaele

doi:10.1530/eje-18-0253

Cited by 38 publications

(27 citation statements)

References 36 publications

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“…Omission of ablation exposes the patients to the risk of late diagnosis of residual disease. (28, 29) Finally, early reassurance and simplified follow-up are only possible when patients had received total thyroidectomy followed by therapeutic 131 I administration for remnant ablation and/or adjuvant treatment.…”

Section: Diagnostic and Post-therapy 131i Scintigraphymentioning

confidence: 99%

Thyroid cancer radiotheragnostics: the case for activity adjusted 131I therapy

Avram

Dewaraja

2018

Clin Transl Imaging

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Radiotheragnostics represents the systematic integration of diagnostic imaging and therapeutics using radionuclides targeting specific characteristics of tumor biology. Radioiodine (131I) is the classic radiotheragnostic agent used for the diagnosis and treatment of differentiated thyroid cancer (DTC) based on sodium-iodine symporter expression in normal and neoplastic thyroid tissue. Application of radiotheragnostics principles in thyroid cancer involves using pre-ablation diagnostic scans (Dx Scans) for detection of iodine-avid regional and distant metastatic disease and patient-individualized targeted 131I therapy with goal of maximizing the benefits of the first therapeutic 131I administration. Clinically available nuclear medicine imaging technology has significantly evolved over the past 10 years with the introduction of hybrid SPECT/CT and PET/CT systems, as well as advances in iterative image reconstruction with modeling of image degrading physical factors. This progress makes possible the acquisition of accurate diagnostic radioiodine scintigraphy capable of identifying regional and distant metastatic disease, which can be used for 131I treatment planning and delivery of activity adjusted 131I therapy for achieving intended treatment goals (e.g. remnant ablation, adjuvant 131I treatment and targeted 131-I treatment). The overarching aim of thyroid cancer radiotheragnostics is to optimize the balance between 131I therapeutic efficacy and potential side-effects on non-target tissues.

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Section: Diagnostic and Post-therapy 131i Scintigraphymentioning

confidence: 99%

Thyroid cancer radiotheragnostics: the case for activity adjusted 131I therapy

Avram

Dewaraja

2018

Clin Transl Imaging

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“…Furthermore, TC patients with aggressive histology such as medullary thyroid carcinoma and anaplastic thyroid carcinoma have a poor prognosis 19–21 . Therefore, early detection and proper management are very important to improve the prognosis in TC patients with initial distant metastasis or aggressive histology 22 .…”

Section: Introductionmentioning

confidence: 99%

Improved survival after early detection of asymptomatic distant metastasis in patients with thyroid cancer

Kim

Park

Jung

et al. 2019

Sci Rep

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The incidence of thyroid cancer (TC) has been increasing in many countries and concerns about overdiagnosis are also widely shared. However, early detection may be helpful in some high-risk TC patients, such as those with initial distant metastasis. We conducted this study to evaluate the usefulness of early detection in TC patients with initial distant metastasis. We retrospectively reviewed the clinical data of 13,249 TC patients, and found 127 patients with initial distant metastasis. Enrolled patients were divided into two groups according to the diagnostic periods; before and after 2004, when the early detection of TC by ultrasonography began in earnest in Korea. Patients were also divided into two groups according to the presence of symptoms. Prior to 2004, 33 patients (1.7% of TC patients) were diagnosed with TC with initial distant metastasis and 16 (48.5%) of them died. After 2004, 94 patients (0.8% of TC patients) were diagnosed with TC with initial distant metastasis and 29 (30.9%) of them died. Prior to 2004, the disease-specific death rates were similar between the asymptomatic and symptomatic groups (46.2% vs. 50.0%, P = 0.566). Conversely, after 2004, the asymptomatic group showed a significantly lower disease-specific death rate as compared with that of the symptomatic groups (17.2% vs. 60.0%; P < 0.001). Early detection had a significant positive impact on survival outcomes only after 2004, especially in asymptomatic TC patients with initial distant metastasis.

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“…Differentiated thyroid cancer (DTC) is the most frequent endocrine cancer, which is usually characterized by a favorable outcome and a long-term survival [1] in patients without distant metastases [2]. The initial therapy consists of total thyroidectomy followed by postoperative sodium iodide [ 131 I] ([ 131 I]) treatment in most cases.…”

Section: Introductionmentioning

confidence: 99%

Thyroglobulin doubling time offers a better threshold than thyroglobulin level for selecting optimal candidates to undergo localizing [18F]FDG PET/CT in non-iodine avid differentiated thyroid carcinoma

Albano

Tülchinsky

Dondi

et al. 2020

Eur J Nucl Med Mol Imaging

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Purpose To investigate the potential role of serum thyroglobulin doubling time (TgDT) in predicting 2-deoxy-2-[ 18 F]fluoro-Dglucose ([ 18 F]FDG) PET/CT results in patients affected by differentiated thyroid carcinoma (DTC) who demonstrated a combination of positive Tg but a negative [ 131 I] whole-body scan ([ 131 I]-WBS). Materials and methods Inclusion criteria were (1) prior [ 131 I] treatment for DTC, (2) negative subsequent [ 131 I]-WBS, (3) no interfering anti-Tg antibodies, (4) three consecutive Tg measurements under the thyroid hormone replacement therapy to calculate TgDT before 2-[ 18 F]FDG PET/CT, and (5) at least 6 months of clinical and/or imaging follow-up to ascertain the diagnosis. Receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to identify the optimal cutoff point for the last stimulated Tg and TgDT prior to [ 18 F]FDG PET/CT. Results One hundred and thirteen patients were included. Seventy-four (65%) patients had positive [ 18 F]FDG PET/CT for DTC recurrence, while the remaining 39 (35%) negative. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of [ 18 F]FDG PET/CT were 92%, 94%, 97%, 87%, and 93%. Patients with positive [ 18 F]FDG PET/CT had higher Tg and TgDT than those with negative PET/CT. ROC curve analysis revealed an optimal Tg cutoff of 19 ng/mL (sensitivity 78%, specificity 85%, AUC = 0.844) and TgDT of 2.5 years (sensitivity 93%, specificity 87%, AUC = 0.911). TgDT threshold of 2.5 years predicted significantly (p = 0.023) better than Tg level PET/CT results. Conclusions The diagnostic performance of [ 18 F]FDG PET/CT could be significantly improved when TgDT is less than or equal to 2.5 years, as compared with using the absolute Tg level. Keywords Thyroglobulin doubling time. Differentiated thyroid carcinoma. Thyroglobulin. [ 18 F]FDG PET/CT. Diagnostic test performance This article is part of the Topical Collection on Endocrinology

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Possible delayed diagnosis and treatment of metastatic differentiated thyroid cancer by adopting the 2015 ATA guidelines

Abstract: According to the 2015 ATA guidelines, most of metastatic patients would not have been treated after surgery, with the risk of late diagnosis and delayed treatment.

Cited by 38 publications

References 36 publications

Thyroid cancer radiotheragnostics: the case for activity adjusted 131I therapy

Thyroid cancer radiotheragnostics: the case for activity adjusted 131I therapy

Improved survival after early detection of asymptomatic distant metastasis in patients with thyroid cancer

Thyroglobulin doubling time offers a better threshold than thyroglobulin level for selecting optimal candidates to undergo localizing [18F]FDG PET/CT in non-iodine avid differentiated thyroid carcinoma

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