Value of Thyroid Carcinoma Imaging After Therapeutic Doses of Radioiodine

Balachandran, Suppiah; Sayle, Bettye A.

doi:10.1097/00003072-198104000-00006

Cited by 24 publications

(13 citation statements)

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“…In postthyroidectomy patients, SPECT/CT findings affected the ATA risk classification, with implications for management by changing the interval for clinical followup and the need for additional imaging and laboratory tests. We elected to evaluate the role of SPECT/CT in the posttherapy setting, because the administered activity is 10-to 30-fold greater than that used for diagnostic studies, and the longer interval between activity administration and imaging increases target-to-background contrast, resulting in the detection of more sites of radioiodine-avid disease, compared with the diagnostic study (12)(13)(14). Other authors also evaluated SPECT/CT in this setting, but in some studies SPECT/CT was obtained only in light of equivocal planar scans (2,6,11,15).…”

Section: Discussionmentioning

confidence: 99%

The Effect of Posttherapy ¹³¹I SPECT/CT on Risk Classification and Management of Patients with Differentiated Thyroid Cancer

Grewal

Tuttle²,

Fox³

et al. 2010

J Nucl Med

100

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The objective of this study was to determine whether posttherapy 131 I SPECT/CT changed the need for additional crosssectional imaging or modified the American Thyroid Association risk of recurrence classification. We performed planar imaging and SPECT/CT in a consecutive series of patients after 131 I therapy. Methods: Planar imaging and SPECT/CT were performed on 148 consecutive patients with thyroid carcinoma (125 papillary, 2 follicular, 8 Hü rthle cell, and 13 poorly differentiated) approximately 5 d after the therapeutic administration of 1,739-8,066 MBq (47-218 mCi) of 131 I. The indication for treatment was postsurgical ablation (n 5 109) or recurrent or metastatic disease with rising thyroglobulin levels (n 5 39). SPECT/CT scans were obtained for all subjects for 1 bed position (38 cm), which included the neck and upper chest. Additional SPECT/CT scans of the abdomen or pelvis were acquired if suggestive findings were noted on planar images. All patients were treated in real time, according to the standard of care in our practice. At that time, clinical decisions regarding thyroid tumor classification were made by our multidisciplinary group based on all data, including operative findings, pathology, imaging, and thyroglobulin levels. In a retrospective analysis, planar and SPECT/CT images were interpreted independently, and sites of uptake were categorized as likely benign, malignant, or equivocal. An experienced thyroid endocrinologist used a combination of surgical histopathology and scan findings to determine whether additional cross-sectional imaging was required and determined if the imaging findings changed the patient's risk category. Results: In 29 patients, 61 additional cross-sectional imaging studies were avoided using SPECT/ CT, compared with medical decision making based on the planar images alone. In 7 of 109 postsurgical patients, SPECT/CT findings changed the initial American Thyroid Association risk of recurrence classification. The sensitivity of planar imaging and SPECT/CT for identification of focal 131 I uptake in the thyroid bed was similar in the postsurgical and recurrence cohorts. For metastatic disease in the neck, characterization of 131 I uptake by SPECT/CT in the postsurgical group was significantly better than that by planar scanning (P , 0.01). Among the 109 postsurgical patients, the characterization of iodine uptake in the lung, liver, and bone was also more accurate using SPECT/ CT than planar scanning (P , 0.01). The CT portion of SPECT/CT demonstrated non-iodine-avid lesions in 32 of 148 patients. Conclusion: SPECT/CT data provided information that reduced the need for additional cross-sectional imaging in 29 patients (20%) and significantly altered the initial risk of recurrence estimates in 7 of 109 patients (6.4%), thereby altering patient management recommendations with regard to frequency and intensity of follow-up studies.

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Section: Discussionmentioning

confidence: 99%

The Effect of Posttherapy ¹³¹I SPECT/CT on Risk Classification and Management of Patients with Differentiated Thyroid Cancer

Grewal

Tuttle²,

Fox³

et al. 2010

J Nucl Med

100

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“…whether one knows that the patient has undergone radioactive iodine imaging that maximizes identification of functioning DTC foci. Finally, it is well documented in the literature that a diagnostic radioactive iodine scan is frequently negative, but the post-131 I therapy scan is positive for functioning 131 I-avid metastases (47)(48)(49)(50)(51)(52)(53). Although this scenario may be associated with an increased likelihood that the patient has 131 Irefractory DTC, it does indicate that the tumor retains 131 I avidity and may be 131 I responsive.…”

Section: Introductionmentioning

confidence: 99%

Controversies, Consensus, and Collaboration in the Use of ¹³¹I Therapy in Differentiated Thyroid Cancer: A Joint Statement from the American Thyroid Association, the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the European Thyroid Association

Tuttle

Ahuja

Avram

et al. 2019

Thyroid

294

212

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Background: Publication of the 2015 American Thyroid Association (ATA) management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer was met with disagreement by the extended nuclear medicine community with regard to some of the recommendations related to the diagnostic and therapeutic use of radioiodine (131 I). Because of these concerns, the European Association of Nuclear Medicine and the Society of Nuclear Medicine and Molecular Imaging declined to endorse the ATA guidelines. As a result of these differences in opinion, patients and clinicians risk receiving conflicting advice with regard to several key thyroid cancer management issues. Summary: To address some of the differences in opinion and controversies associated with the therapeutic uses of 131 I in differentiated thyroid cancer constructively, the ATA, the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the European Thyroid Association each sent senior leadership and subject-matter experts to a two-day interactive meeting. The goals of this first meeting were to (i) formalize the dialogue and activities between the four societies; (ii) discuss indications for 131 I adjuvant treatment; (iii) define the optimal prescribed activity of 131 I for adjuvant treatment; and (iv) clarify the definition and classification of 131 I-refractory thyroid cancer. Conclusion: By fostering an open, productive, and evidence-based discussion, the Martinique meeting restored trust, confidence, and a sense of collegiality between individuals and organizations that are committed to optimal thyroid disease management. The result of this first meeting is a set of nine principles (The Martinique

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“…Nemec and colleagues (4) identified new uptake in 16% of PTS. Balachandran and colleagues (5) reported similar studies. In these studies rectilinear scans were used, which might have had less sensitivity.…”

Section: Discussionmentioning

confidence: 67%

“…At the time of PTS clinical or radiologie evidence of metastatic or residual disease was present in 68 patients (84%). The anatomic sites of known disease included, neck (63), mediastinum (23), lung (35), bone (14), trachea (16), esophagus (5), and brain (2).…”

Section: Demographics and Clinical Featuresmentioning

confidence: 99%

“…Areas with abnormal new uptake included: neck (5), lung (5), mediastinum (4), bone (2), and adrenal (1). Possible new uptake was seen in another 10 scans (8%), and in 18 scans (15%) PTS was helpful in interpretation of questionable uptake in diagnostic scan, either confirming or excluding the suspected areas of questionable uptake.…”

Section: Discordant Findings Between Diagnostic Scan and Ptsmentioning

confidence: 99%

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Are Posttherapy Radioiodine Scans Informative and Do They Influence Subsequent Therapy of Patients with Differentiated Thyroid Cancer?

Fatourechi

Hay

Mullan³

et al. 2000

Thyroid

115

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Value of Thyroid Carcinoma Imaging After Therapeutic Doses of Radioiodine

Cited by 24 publications

References 0 publications

The Effect of Posttherapy ¹³¹I SPECT/CT on Risk Classification and Management of Patients with Differentiated Thyroid Cancer

The Effect of Posttherapy ¹³¹I SPECT/CT on Risk Classification and Management of Patients with Differentiated Thyroid Cancer

Are Posttherapy Radioiodine Scans Informative and Do They Influence Subsequent Therapy of Patients with Differentiated Thyroid Cancer?

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Value of Thyroid Carcinoma Imaging After Therapeutic Doses of Radioiodine

Cited by 24 publications

References 0 publications

The Effect of Posttherapy 131I SPECT/CT on Risk Classification and Management of Patients with Differentiated Thyroid Cancer

The Effect of Posttherapy 131I SPECT/CT on Risk Classification and Management of Patients with Differentiated Thyroid Cancer

Controversies, Consensus, and Collaboration in the Use of 131I Therapy in Differentiated Thyroid Cancer: A Joint Statement from the American Thyroid Association, the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the European Thyroid Association

Are Posttherapy Radioiodine Scans Informative and Do They Influence Subsequent Therapy of Patients with Differentiated Thyroid Cancer?

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The Effect of Posttherapy ¹³¹I SPECT/CT on Risk Classification and Management of Patients with Differentiated Thyroid Cancer

The Effect of Posttherapy ¹³¹I SPECT/CT on Risk Classification and Management of Patients with Differentiated Thyroid Cancer