title: Persistent disease and recurrence in differentiated thyroid cancer patients with undetectable postoperative stimulated thyroglobulin level.
abstract: (131)I is given in differentiated thyroid cancer (DTC) without taking into account thyroglobulin (Tg) levels at the time of ablation, whereas 6-18 months later it is a major criterion for cure. This single-center retrospective study assessed the frequency and risk factors for persistent disease on postablation whole body scan (WBS) and postoperative neck ultrasonography (n-US) and for recurrent disease during the subsequent follow-up, in patients with DTC and undetectable TSH-stimulated Tg level (TSH-Tg) in the absence of Tg antibodies (TgAb) at the time of ablation. Among 1031 patients ablated, 242 (23%) consecutive patients were included. Persistent disease occurred in eight cases (3%) (seven abnormal WBS and one abnormal n-US), all with initial neck lymph node metastases (N1). N1 was a major risk factor for persistent disease. Among 203 patients with normal WBS and a follow-up over 6 months, TSH-Tg 6-18 months after ablation was undetectable in the absence of TgAb in 173 patients, undetectable with TgAb in 1 patient and equal to 1.2  ng/ml in 1 patient. n-US was normal in 152 patients and falsely positive in 3 patients. After a mean follow-up of 4 years, recurrence occurred in two cases (1%), both with aggressive histological variants. The only risk factor for recurrence was an aggressive histological variant (P = 0.03). In conclusion, undetectable postoperative TSH-Tg in the absence of TgAb at the time of ablation is frequent. In these patients, repeating TSH-Tg 6-18 months after ablation is not useful. (131)I ablation could be avoided in the absence of N1 and aggressive histological variant.
authors.affiliation: Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy, Univ. Paris-Sud, Villejuif, France.
authors.forename: C
authors.initials: C
authors.lastname: Nascimento
authors.forename: I
authors.initials: I
authors.lastname: Borget
authors.forename: A
authors.initials: A
authors.lastname: Al Ghuzlan
authors.forename: D
authors.initials: D
authors.lastname: Deandreis
authors.forename: L
authors.initials: L
authors.lastname: Chami
authors.forename: J P
authors.initials: JP
authors.lastname: Travagli
authors.forename: D
authors.initials: D
authors.lastname: Hartl
authors.forename: J
authors.initials: J
authors.lastname: Lumbroso
authors.forename: C
authors.initials: C
authors.lastname: Chougnet
authors.forename: L
authors.initials: L
authors.lastname: Lacroix
authors.forename: E
authors.initials: E
authors.lastname: Baudin
authors.forename: M
authors.initials: M
authors.lastname: Schlumberger
authors.forename: S
authors.initials: S
authors.lastname: Leboulleux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D018265:Carcinoma, Papillary, Follicular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002454:Cell Differentiation / Q000502:physiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011877:Radionuclide Imaging; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D013954:Thyroglobulin / Q000097:blood*; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014463:Ultrasonography; D015854:Up-Regulation / Q000528:radiation effects; D055815:Young Adult
chemical_list: D007457:Iodine Radioisotopes; D013954:Thyroglobulin