Farise YILMAZ, Hasan ÖNNER, Gonca KARA GEDİK

Diferansiye Tiroid Kanserlerinde ablasyon sonrası görüntülemede boyun ve toraks bölgesindeki odakların ayırıcı tanısında SPECT-BT'nin Planar görüntülemeye katkısı ve klinik önemi

Amaç: Bu çalışmanın amacı, diferansiye tiroid kanserli (DTC) hastalarda I-131 ablasyon tedavisi sonrası odakların benign-malign ayrımını ve hasta yönetimini ayırt etmede Tek Foton Emisyonlu Bilgisayarlı Tomografi-Bilgisayarlı Tomografi’nin (SPECT-CT) planar görüntülemeye (WBS) göre üstünlüğünü göstermeyi amaçlamaktadır. Gereç ve Yöntem: Tiroid kanseri nedeniyle I-131 tedavisi alan 80 hastanın, planar WBS ve SPECT-CT bulguları retrospektif olarak incelendi. Planar görüntülerdeki boyun ve torakstaki olası odaklar SPECT-CT ile karşılaştırıldı. 2015 Amerikan Tiroid Birliği (ATA) yönergelerine göre hastalar üç gruba ayrıldı: Yüksek, orta ve düşük risk grupları. Her iki görüntüleme arasındaki yorum değişiklikleri downstage ve upstage olarak kaydedildi. Bulgular: 53 kadın ve 27 erkek hasta vardı. Hastaların yaşları 21 ile 88 arasında değişmekte olup, ortalama yaş 47 ±14.2 idi. 80 hastada planar ve SPECT görüntülerinde (boyun: 118, toraks: 21) 139 odak tespit edildi. SPECT-CT, lateral boyun odaklarının %50'sinin malign patolojilerle, %50'sinin de benign patolojilerle uyumlu olduğunu ortaya koydu. Boyun orta kısmındaki odakların sadece tiroid kalıntısı (%56) değil, önemli oranda tiroglossal kanal kalıntısı (%40) odakları olduğu saptandı. Toraks bölgesindeki odakların %66'sının akciğer metastazı olduğu belirlendi. %34'ü ise kemik metastazıydı. Mediastinal bölgedeki odakların %33'ünün lenf düğümleri olduğu tespit edildi. Geriye kalan hastaların sadece birinde patolojik tanı olmasına rağmen diğerlerinin de timus patolojisi olabileceği düşünüldü. SPECT-CT, 5'i (%6.25) upstage ve 13'ü (%16.25) downstage olmak üzere 18 hastanın (%22.5) yorumunu değiştirdi. Sonuç: Özellikle şüpheli fokal lezyonları olan orta/yüksek riskli hastalarda SPECT-CT kullanımı hasta yönetimini kolaylaştırmış olup gereksiz invazif işlemlerden kaçınılmasında etkili olmuştur. Boyunda tiroid kalıntısı dışında iyot tutulumu gösteren benign iyot tutulumu olan odakların (tiroglossal kanal kalıntısı vb.) varlığı düşük riskli hastalarda ablasyon kararı vermede etkili olabilir.

Contribution of SPECT-CT to planar imaging in post-ablation imaging in different thyroid cancers, the clinical significance of the differential diagnosis of neck and thorax uptakes

Background: The aim of this study is to demonstrate the superiority of Single Photon Emission Computed Tomography-Computed Tomography (SPECT-CT) over planar imaging in distinguishing benign from malignant foci and patient management after 131I ablation therapy in patients with differentiated thyroid cancer (DTC). Material and Methods: Planar and SPECT-CT imaging findings were retrospectively analyzed in 80 patients who received I-131 therapy for thyroid cancer. Possible foci in whole body scanning (WBS), neck, and thorax were compared with SPECT-CT. Anatomical localization of the foci and differential diagnosis of the benign and malignant lesion was made with SPECT-CT. Those without anatomical counterparts were recorded as equivocal foci. According to the 2015 American Thyroid Association (ATA) guidelines, patients were divided into three groups: High, intermediate, low-risk groups. Interpretation changes between both scannings were recorded as downstage and upstage. Results: There were 53 female and 27 male patients. The patients' age ranged from 21 to 88 years with a mean age of 47 ±14.2. In 80 patients, 139 foci were detected in planar images and SPECT-CT images (neck: 118, thorax: 21). SPECT-CT revealed that 50% of the lateral neck foci were compatible with pathologies in malignant nature and 50% with pathologies in benign nature. Foci in the middle part of the neck were found to be not only thyroid remnant (56%), but also thyroglossal duct remnant (40%) foci at a significant rate It was determined that 66% of the foci in the thorax region were lung metastases and 34% were bone metastases. It was proved that 33% of the foci in the mediastinal region were lymph nodes. Although only one of the remaining patients had a pathological diagnosis, it was thought that all of them might have thymus pathologies. SPECT-CT images changed the interpretation of 18 patients (22.5%), of which 5 (6.25%) were upstage and 13 (16.25%) were downstage. Conclusions: The use of SPECT-CT will be very effective, facilitating patient management and avoiding unnecessary procedures, especially in moderate/high-risk patients with suspicious focal lesions. The presence of benign iodine avid foci (thyroglossal duct residue, etc.) in the neck showing iodine uptake other than the thyroid remnant may be effective in making ablation decisions in low-risk patients.

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Hedman C, Djärv T, Strang P, Lundgren CI. Effect of Thyroid-Related Symptoms on Long-Term Quality of Life in Patients with Differentiated Thyroid Carcinoma: A Population-Based Study in Sweden. Thyroid: official journal of the American Thyroid Association. 2017;27(8):1034-42.
Liu C, Zhao Q, Li Z, Wang S, Xiong Y, Liu Z, et al. Mixed subtype thyroid cancer: A surveillance, epidemiology, and end results database analysis. Oncotarget. 2017;8(49):86556-65.
Luster M, Clarke SE, Dietlein M, Lassmann M, Lind P, Oyen WJ, et al. Guidelines for radioiodine therapy of differentiated thyroid cancer. European journal of nuclear medicine and molecular imaging. 2008;35(10):1941-59.
Vojvodich SM, Ballagh RH, Cramer H, Lampe HB. Accuracy of fine needle aspiration in the pre-operative diagnosis of thyroid neoplasia. The Journal of otolaryngology. 1994;23(5):360-5.
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133.
Zilioli V, Peli A, Panarotto MB, Magri G, Alkraisheh A, Wiefels C, et al. Differentiated thyroid carcinoma: Incremental diagnostic value of (131)I SPECT/CT over planar whole body scan after radioiodine therapy. Endocrine. 2017;56(3):551-9.
Jeong SY, Lee SW, Kim HW, Song BI, Ahn BC, Lee J. Clinical applications of SPECT/CT after first I-131 ablation in patients with differentiated thyroid cancer. Clinical endocrinology. 2014;81(3):445-51.
Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995 [see commetns]. Cancer. 1998;83(12):2638-48.
Bongiovanni M, Paone G, Ceriani L, Pusztaszeri MJC, Imaging T. Cellular and molecular basis for thyroid cancer imaging in nuclear medicine. 2013;1(3):149-61.
Glazer DI, Brown RK, Wong KK, Savas H, Gross MD, Avram AM. SPECT/CT evaluation of unusual physiologic radioiodine biodistributions: pearls and pitfalls in image interpretation. Radiographics. 2013;33(2):397-418.
Spanu A, Solinas ME, Chessa F, Sanna D, Nuvoli S, Madeddu G. 131I SPECT/CT in the follow-up of differentiated thyroid carcinoma: incremental value versus planar imaging. Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2009;50(2):184-90.
Schmidt D, Linke R, Uder M, Kuwert T. Five months' follow-up of patients with and without iodine-positive lymph node metastases of thyroid carcinoma as disclosed by (131)I-SPECT/CT at the first radioablation. European journal of nuclear medicine and molecular imaging. 2010;37(4):699-705.
Schmidt D, Szikszai A, Linke R, Bautz W, Kuwert T. Impact of 131I SPECT/spiral CT on nodal staging of differentiated thyroid carcinoma at the first radioablation. Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2009;50(1):18-23.
Maruoka Y, Abe K, Baba S, Isoda T, Sawamoto H, Tanabe Y, et al. Incremental diagnostic value of SPECT/CT with 131I scintigraphy after radioiodine therapy in patients with well-differentiated thyroid carcinoma. Radiology. 2012;265(3):902-9.
Malamitsi JV, Koutsikos JT, Giourgouli SI, Zachaki SF, Pipikos TA, Vlachou FJ, et al. I-131 Postablation SPECT/CT Predicts Relapse of Papillary Thyroid Carcinoma more Accurately than Whole Body Scan. In vivo (Athens, Greece). 2019;33(6):2255-63.
Xue YL, Qiu ZL, Song HJ, Luo QY. Value of ¹³¹I SPECT/CT for the evaluation of differentiated thyroid cancer: a systematic review of the literature. European journal of nuclear medicine and molecular imaging. 2013;40(5):768-78.
Avram AM. Radioiodine scintigraphy with SPECT/CT: an important diagnostic tool for thyroid cancer staging and risk stratification. Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2012;53(5):754-64.
Barwick T, Murray I, Megadmi H, Drake WM, Plowman PN, Akker SA, et al. Single photon emission computed tomography (SPECT)/computed tomography using Iodine-123 in patients with differentiated thyroid cancer: additional value over whole body planar imaging and SPECT. European journal of endocrinology. 2010;162(6):1131-9.
Kohlfuerst S, Igerc I, Lobnig M, Gallowitsch HJ, Gomez-Segovia I, Matschnig S, et al. Posttherapeutic (131)I SPECT-CT offers high diagnostic accuracy when the findings on conventional planar imaging are inconclusive and allows a tailored patient treatment regimen. European journal of nuclear medicine and molecular imaging. 2009;36(6):886-93.
Hassan FU, Mohan HK. Clinical Utility of SPECT/CT Imaging Post-Radioiodine Therapy: Does It Enhance Patient Management in Thyroid Cancer? European thyroid journal. 2015;4(4):239-45. 21. Ziessman HA, O'Malley JP, Thrall JH. Nuclear medicine: The requisites e-book: Elsevier Health Sciences; 2013.
Lee M, Lee YK, Jeon TJ, Chang HS, Kim BW, Lee YS, et al. Frequent visualization of thyroglossal duct remnant on post-ablation 131I-SPECT/CT and its clinical implications. Clin Radiol. 2015;70(6):638-43.
Barber TW, Cherk MH, Topliss DJ, Serpell JW, Yap KS, Bailey M, et al. The prevalence of thyroglossal tract thyroid tissue on SPECT/CT following (131) I ablation therapy after total thyroidectomy for thyroid cancer. Clinical endocrinology. 2014;81(2):266-70.
Vermiglio F, Baudin E, Travagli JP, Caillou B, Fragu P, Ricard M, et al. Iodine concentration by the thymus in thyroid carcinoma. Journal of Nuclear Medicine. 1996;37(11):1830-1.
Arce MB, Molina TC, Hernández TM, Morón MdlCC, Herrero CH, Pérez PADLR, et al. Thymic uptake after high-dose I-131 treatment in patients with differentiated thyroid carcinoma: A brief review of possible causes and management. Endocrinología y Nutrición. 2015;62(1):19-23.
Mello ME, Flamini RC, Corbo R, Mamede M. Radioiodine concentration by the thymus in differentiated thyroid carcinoma: report of five cases. Arq Bras Endocrinol Metabol. 2009;53(7):874-9.