title: Remnant uptake as a postoperative oncologic quality indicator.
abstract: BACKGROUND
  The purpose of this study was to examine the utility of remnant uptake on postoperative radioiodine scans as an oncologic indicator after thyroidectomy for differentiated thyroid cancer (DTC).
  
  
  METHODS
  We conducted a retrospective review of patients undergoing total thyroidectomy for DTC and subsequent radioactive iodine (RAI) treatment. Of the eight surgeons included, three were considered high volume, performing at least 20 thyroidectomies per year. Patients with distant metastases at diagnosis or poorly differentiated variants were excluded. To control for the effect of varying RAI doses, the remnant uptake was analyzed as a ratio of the percentage uptake to the dose received (uptake to dose ratio [UDR]). Multivariate logistic regression was used to determine the influence of UDR on recurrence.
  
  
  RESULTS
  Of the 223 patients who met inclusion criteria, 21 patients (9.42%) experienced a recurrence. Those with a recurrence had a 10-fold higher UDR compared with those who did not (0.030 vs. 0.003, p=0.001). Similarly, patients with increasing postoperative thyroglobulin measurements (0.339 vs. 0.003, p<0.001) also had significantly greater UDRs compared with those with stable thyroglobulin. The UDRs of high-volume surgeons were significantly smaller than low-volume surgeons (0.003 vs. 0.025, p=0.002). When combined with other known predictors for recurrence, UDR (OR 3.71 [95%CI 1.05-13.10], p=0.041) was significantly associated with recurrence. High-volume surgeons maintained a low level of permanent complications across all UDRs, whereas low-volume surgeons had greater permanent complications associated with higher uptake.
  
  
  CONCLUSIONS
  Remnant uptake is a useful postoperative oncologic quality indicator that can predict a patient's risk of disease recurrence and indicate the completeness of resection.
authors: Section of Endocrine Surgery, Department of Surgery, University of Wisconsin , Madison, Wisconsin.
authors: David F
authors: DF
authors: Schneider
authors: Kristin A
authors: KA
authors: Ojomo
authors: Herbert
authors: H
authors: Chen
authors: Rebecca S
authors: RS
authors: Sippel
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging* / Q000528:radiation effects / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D011184:Postoperative Period; D011379:Prognosis; D019984:Quality Indicators, Health Care; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use; D012189:Retrospective Studies; D016019:Survival Analysis; D013961:Thyroid Gland / Q000000981:diagnostic imaging* / Q000528:radiation effects / Q000601:surgery; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000517:prevention & control / Q000628:therapy; D013965:Thyroidectomy / Q000009:adverse effects; D014018:Tissue Distribution
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals
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