[Chest X ray: routine indication in the follow-up of differentiated thyroid cancer?].
OBJECTIVE
This retrospective study sought to elucidate whether routine chest x-ray is still useful for detection of pulmonary metastases in low risk patients despite the high sensitivity of the tumor marker thyroglobulin.


METHODS
The hospital files of 609 patients with well-differentiated thyroid cancer were analysed. Pulmonary formation of metastases was diagnosed in 50 patients. The thyroglobulin value at the time of diagnosis was compared with the chest x-ray findings and, if present, additional diagnostic information such as Iodine-131 whole body scintigraphy (WBS) and thorax CT.


RESULTS
The sensitivity of the chest x-ray to detect pulmonary metastases was at 52% lower than that of WBS (64%), thorax CT (82%) and thyroglobulin during suppression therapy (86%). Among the patients with papillary carcinoma stage I and II (UICC 1987), only 1 patient developed pulmonary metastases during follow up. In this low risk group of patients, detection of lung metastases exclusively by chest x-ray, without elevation of thyroglobulin level is extremely rare (calculated probability 1/4000) and associated with considerable costs.


CONCLUSIONS
Routine, life long chest x-ray in low risk patients without a suspected recurrence (e.g. positive thyroglobulin) needs to be reconsidered.
Aus der Abteilung Nuklearmedizin, Radiologische Klinik, Universitätskrankenhaus Hamburg-Eppendorf, Deutschland.
J
J
Lorenzen
M
M
Beese
J
J
Mester
K
K
Brumma
W
W
Beyer
M
M
Clausen
D002291:Carcinoma, Papillary / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D003955:Diagnostic Tests, Routine; D006801:Humans; D007457:Iodine Radioisotopes; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary*; D009367:Neoplasm Staging; D013902:Radiography, Thoracic; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013954:Thyroglobulin / Q000097:blood; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology
D007457:Iodine Radioisotopes; D013954:Thyroglobulin
Der Röntgenthorax: Routineindikation in der Nachsorge des differenzierten Schilddrüsenkarzinoms?