Thyroglobulin determination, neck ultrasonography and iodine-131 whole-body scintigraphy in differentiated thyroid carcinoma.
The long-term prognosis of patients with differentiated thyroid carcinoma depends on the early diagnosis and treatment of metastases and local recurrences. We evaluated serum thyroglobulin measurements, neck ultrasonography with ultrasound-guided biopsy and 131I whole-body scintigraphy in the follow-up of 359 patients after surgical thyroidectomy and radioiodine ablation of the thyroid remnant.


METHODS
Serum thyroglobulin levels were determined and considered abnormal when the values were > 5 ng/ml. Ultrasonography over the entire neck region and fine-needle aspiration biopsy of the mass or enlarged lymph nodes were carried out using 5- and 7.5-MHz transducers and 23-gauge needles. Whole-body scintigraphy was performed after administration of 185 MBq (5 mCi)131I.


RESULTS
Increased levels of thyroglobulin (ranging from 12 to > 600 ng/ml) were measured in 40 of 55 (73%) patients with metastases or local recurrences. Ultrasonography revealed occult neck masses that were not detected by other methods. Neck ultrasonography and ultrasound-guided biopsy were positive for malignancy in 23 patients. Thyroglobulin levels were undetectable in 12 (52%) of these patients and 131I whole-body scintigraphy was negative in 19 (83%) of them.


CONCLUSIONS
The combined use of three diagnostic modalities (measurement of serum thyroglobulin, neck ultrasonography with ultrasound-guided biopsy for detecting recurrences of carcinoma in the neck region and 131I whole-body scintigraphy) appears to give the best results in the follows-up patients with differentiated thyroid carcinoma.
Franceschi
M
M
Department of Nuclear Medicine and Oncology, University Hospital, Sestre Milosrdnice, Zagreb, Croatia.
Kusić
Z
Z
Franceschi
D
D
Lukinac
L
L
Roncević
S
S
D018263:Adenocarcinoma, Follicular / Q000175:diagnosis* / Q000453:epidemiology / Q000556:secondary / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods; D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000453:epidemiology / Q000556:secondary / Q000628:therapy; D016022:Case-Control Studies; D002648:Child; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011379:Prognosis; D013954:Thyroglobulin / Q000097:blood*; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D013965:Thyroidectomy; D013997:Time Factors; D014463:Ultrasonography
D007457:Iodine Radioisotopes; D013954:Thyroglobulin