title: Postablation (131)I scintigraphy with neck and thorax SPECT-CT and stimulated serum thyroglobulin level predict the outcome of patients with differentiated thyroid cancer.
abstract: OBJECTIVE
  Neck and thorax single photon emission computed tomography with computed tomography (SPECT-CT) improves the reliability of postablation (131)I whole-body scan (WBS) for differentiated thyroid cancer (DTC). The aim of this study was to assess the prognostic value for persistent or recurrent disease of postablation (131)I scintigraphy combining WBS and neck and thorax SPECT-CT with that of the previously known predictive factors.
  
  
  METHODS
  This is a single referral center prospective study with a median follow-up of 29 months. Postablation (131)I WBS and neck and thorax SPECT-CT were performed in 170 consecutive patients treated between 2006 and 2008. Stimulated serum thyroglobulin (Tg) and anti-thyroglobulin antibodies (TgAb) levels were measured. The impact on disease-free survival of age; gender; postablation (131)I scintigraphy; stimulated serum Tg level; T, N, and M status; and macroscopic lymph node involvement was assessed by univariate and multivariate analyses.
  
  
  RESULTS
  Persistent or recurrent disease was observed in 32 (19%) patients. In the whole group of patients, only positive WBS with SPECT-CT was related to an increased risk of persistent or recurrent disease (hazards ratio (HR)=65.21, 95% confidence interval (CI)=26.03-163.39, P<0.0001). In patients without TgAb (n=146), both positive WBS with SPECT-CT (HR=18.86, 95% CI=5.02-70.85, P<0.0001) and serum Tg level ≥58 ng/ml (HR=4.42, 95% CI=1.18-16.53, P=0.0271) were associated with an increased risk.
  
  
  CONCLUSIONS
  In patients with DTC, the cross analysis of postablation (131)I scintigraphy with neck and thorax SPECT-CT and stimulated serum Tg level enables early assessment of the risk of persistent or recurrent disease.
authors.affiliation: Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, 3 Avenue Général Harris, BP 5026, F-14076 Caen Cedex 05, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Ciappuccini
authors.forename: Natacha
authors.initials: N
authors.lastname: Heutte
authors.forename: Géraldine
authors.initials: G
authors.lastname: Trzepla
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Rame
authors.forename: Dominique
authors.initials: D
authors.lastname: Vaur
authors.forename: Nicolas
authors.initials: N
authors.lastname: Aide
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bardet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000032:analysis; D002648:Child; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis; D013909:Thorax / Q000000981:diagnostic imaging*; D013954:Thyroglobulin / Q000097:blood*; D013964:Thyroid Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D051598:Whole Body Imaging; D055815:Young Adult
chemical_list: D000906:Antibodies; D013954:Thyroglobulin