Indium-111 octreotide scintigraphy for the detection of non-functioning metastases from differentiated thyroid cancer: diagnostic and prognostic value.
In this prospective study, we evaluated the diagnostic and prognostic value of (111)In-octreotide scintigraphy (SRS) in papillary and follicular thyroid carcinoma (DTC) with increasing thyroglobulin (Tg) levels but no response to treatment with (131)I. Twenty-three consecutive patients (13 female, 10 male; mean age 55 years, range 13-81 years) with progressive DTC were selected for the study. All patients had non-functioning metastases, defined by no or slight uptake of (131)I in metastases. Diagnosis of tumour progression was based on rising Tg levels during follow-up and was confirmed by radiological examination. Uptake on SRS was scored from 0 to 4. Data on initial tumour stage, histology, age, gender, Tg values, TSH levels, (131)I treatment doses, intervals and survival were gathered. Seven patients died during follow-up. The overall sensitivity for the detection of metastases was 74%. The sensitivity was better in patients in whom (131)I whole-body scintigraphy did not show any abnormal uptake (82%; 14/17) than in patients with faint (131)I uptake (50%; 3/6). The 10-year survival rate was significantly different between patients with an uptake score of 0 or 1 (100%) and those with an uptake score of 2, 3 or 4 (33%) ( P=0.001). Gender, log Tg and uptake on SRS significantly correlated with survival, but in stepwise analysis, (111)In-octreotide uptake was selected as the most prognostic independent variable (hazard rate 6.25, P=0.006). We conclude that (111)In-octreotide scintigraphy is a valuable clinical tool for the detection of non-functioning DTC metastases. The uptake seems to correlate with prognosis and survival.
Department of Nuclear Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands. m.p.m.Stokkel@lumc.nl
Marcel P M
MP
Stokkel
Robbert B
RB
Verkooijen
Jan W A
JW
Smit
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary*; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015282:Octreotide / Q000031:analogs & derivatives*; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000532:radiotherapy; D016896:Treatment Outcome; D014915:Whole-Body Counting / Q000379:methods / Q000706:statistics & numerical data
D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; C094279:indium-111-octreotide; D015282:Octreotide