Diferansiye tiroid karsinomu hastalarında I-131 tarama sintigrafisi ile eş zamanlı tiroid sintigrafisi bulguları

Amaç: Diferansiye tiroid kanseri hastalarının takibinde kullanılan en önemli yöntem I-131 tüm vücut tarama sintigrafisidir. I-131 tarama sintigrafisi için gönderilen hastalarda tesadüfen eş zamanlı (1-14 gün ara ile) olarak yapılan Tc-99m perteknetat tiroid sintigrafisi bulgularını iki tetkiki birbiriyle karşılaştırmak amacıyla retrospektif olarak araştırdık. Gereç ve Yöntem: Çalışmaya diferansiye tiroid kanseri tanısı olan 35 hasta (25 Kadın, 10 Erkek; 19-67 yaş; ortalama yaş: 45) dahil edildi. Tarama öncesi en az 3 hafta tiroid hormon replasmanı kesildi ve iyotsuz diyete alındılar. 35 hastaya tarama sintigrafisi ve 12 hastaya eş zamanlı tiroid sintigrafisi yapıldı. Bulgular: Hastaların patolojik tanıları 29 hasta papiller, 3 hasta folliküler, 2 hasta medüller-papiller ve 1 hasta papiller karsinom folliküler varyant olarak belirlendi. Tarama öncesi TSH düzeyleri 31-143 mIU/L (ortalama: 60 mIU/L) aralığında ve eş zamanlı tiroglobulin düzeyleri 0.2-102 ng/mL (ortalama: 14 mIU/L) aralığındaydı. Her iki çekimin yapıldığı 12 hastadan 9’unda iki tetkik birbiriyle uyumlu bulundu. 1 hastanın tarama sintigrafisinde, tiroid sintigrafisinde izlenenden bir fazla odakta tutulum izlendi. 2 hastada tiroid sintigrafisinde hiç tutulum izlenmezken tarama sintigrafisinde rezidü doku izlendi. Çalışmaya dahil edilen 35 tarama hastasından 6’sında boyun dışı dokularda tutulum saptandı. Sonuç: Hasta sayısının düşük olması nedeniyle istatistiksel karşılaştırma yapılamamakla birlikte literatürle uyumlu olarak I-131 tüm vücut tarama sintigrafisinin rezidü dokuyu göstermede tiroid sintigrafisine üstün bulundu. Ayrıca tüm vücudu tarama olanağı sağlaması bakımından tarama sintigrafisi bu hastaların takibinde tercih edilmesi gereken yöntemdir.

Simultaneous thyroid scintigraphy and I-131 whole body scintigraphy findings in patients with differentiated thyroid carcinoma

Objective: The most important follow-up method for differentiated thyroid carcinoma patients is I-131 whole body scintigraphy (WBS). We retrospectively investigated findings of patients who were referred for WBS with incidentally performed concurrent (1-14 day interval) Tc-99m pertechnetate thyroid scintigraphy (TS) findings in order to compare two methods. Materials and Methods: Thirty five patients (25 Female, 10 Male; 19-67 years; mean age: 45 years) with diagnosis of differentiated thyroid carcinoma were included into the study. Their thyroid hormone replacement were stopped and iodine free diet was applied 3 weeks prior to the WBS. Iodine-131 WBS of 35 patients and concurrent TS of 12 patients were evaluated. Results: Pathological diagnoses of patients were: papillary (n=29), follicular (n=3), medullary and papillary (n=2) and follicular variant of papillary carcinoma (n=1). The thyroid stimulating hormone (TSH) levels prior to the WBS were 31-143mIU/L (mean: 60 mIU/L) and thyroglobulin (TG) levels were 0.2-102 ng/mL (mean: 14 mIU/L). Results of 9 out of 12 patients who were evaluated with both WBS and TS were in agreement. One patient had one more focus of residual tissue at WBS which was not seen on TS and 2 patients had residue tissue on WBS but there was no activity on their TS. Additionally 6 patients out of 35 patients had extrathyroidal involvement on WBS. Conclusion: Although statistical analysis couldn’t be performed because of inadequate number of subjects, WBS was found to be superior to TS for showing residual tissue. Additionally in terms of opportunity of scanning whole body, WBS has to be the preferred method to prefer in follow-up of differentiated thyroid cancer patients.

Kaynakça

1. Pacini F, Schlumberger M, Dralle H, et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 2006; 154: 787–803.

2. Giovanella L, Suriano S, Ricci R, Ceriani L, Anton Verburg F. Postsurgical thyroid remnant estimation by (99m) Tc-pertechnetate scintigraphy predicts radioiodine ablation effectiveness in patients with differentiated thyroid carcinoma. Head Neck 2011; 33: 552-6.

3. Lees W, Mansberg R, Roberts R, et al. The clinical effects of thyroid stunning after diagnostic whole-body scanning with 185 MBq 131I. Eur J Nucl Med Mol Imaging 2002; 29: 1421–7.

4. Leger FA, Izembart M, Dagousset F, et al. Decreased uptake of therapeutic doses of iodine-131 after 185-MBq iodine-131 diagnostic imaging for thyroid remnants in differentiated thyroid carcinoma. Eur J Nucl Med 1998; 25: 242–6.

5. Lassmann ML, Luster M, Hanscheid H, et al. Impact of 131I diagnostic activities on the biokinetics of thyroid remnants. J Nucl Med 2004; 45: 619–25.

6. Caglar M, Tuncel M, Alpar R. Value of technetium scintigraphy and iodine uptake measurement during follow-up of differentiated thyroid cancer. Ann Nucl Med 2004; 18: 479-82.

7. Reynolds JC. Percent 131I uptake and post-therapy 131I scans: their role in the management of thyroid cancer. Thyroid 1997; 7: 281–4.

8. Souza Rosario PW, Barroso AL, Rezende LL, et al. Post I-131 therapy scanning in patients with thyroid cancer metastases: anunnecessary cost or a relevant contribution? Clin Nucl Med 2004; 29: 795–8.

9. Thomas DL, Menda Y, Bushnell D.A comparison between diagnostic I-123 and posttherapy I-131 scans in the detection of remnant and locoregional thyroid disease. Clin Nucl Med 2009; 34: 745-8.

10. Al-Nahhas A, Khan S, Gogbashian A, Banti E, Rampin L, Rubello D. Review. 18F-FDG PET in the diagnosis and follow-up of thyroid malignancy. In Vivo 2008; 22: 109-14.

11. Zanotti-Fregonara P, Hindié E, Keller I, Calzada-Nocaudie M, Devaux JY. Scintigraphic visualization of glossal thyroid tissue during the follow-up of thyroid cancer patients. Clin Nucl Med 2007; 32: 911-4.

12. Kueh SS, Roach PJ, Schembri GP. Role of Tc-99m pertechnetate for remnant scintigraphy post-thyroidectomy. Clin Nucl Med 2010; 35: 671-4.

13. Geerlings JA, van Zuijlen A, Lohmann EM, Smit JW, Stokkel MP. The value of I-131 SPECT in the detection of recurrent differentiated thyroid cancer. Nucl Med Commun 2010; 31: 417-22.

14. Grewal RK, Tuttle RM, Fox J, et al. The effect of posttherapy 131I SPECT/CT on risk classification and management of patients with differentiated thyroid cancer. J Nucl Med 2010; 51: 1361-7.

Kaynak Göster

  • ISSN: 1300-9818
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2001

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