İsmail KOÇAK, Hasan ÖNNER, Buğra KAYA, Oktay SARI

DİFERANSİYE TİROİD KANSERİNDE REZİDÜ VE METASTAZIN BELİRLENMESİNDE TÜM VÜCUT TARAMA İLE TİROGLOBULİNİN KARŞILAŞTIRILMASI

AMAÇ: Çalışmamızda, radyoaktif iyot (RAİ) tedavisi alan diferansiye tiroid kanserli (DTK) hastalarda tiroglobulin (Tg) ile tedavi sonrası tüm vücut tarama (TVT) sintigrafisinin rezidü ve/veya metastaz saptamada önemleri karşılaştırılmıştır.GEREÇ VE YÖNTEM: Total ya da totale yakın tiroidektomi cerrahisi geçiren, DTK tanısı alan ve RAİ ablasyon tedavisi verilen hastaların dosyaları retrospektif olarak incelendi. Hastalara RAİ tedavisi öncesi L-Tiroksin tedavisi kesilip, 14 gün iyottan fakir diyet verilerek tedavi öncesinde serum TSH seviyesinin 30 IU/ml’den yüksek olması sağlandı. Tedavi öncesi serum tiroid stimülan hormon (TSH), Tg, tiroglobulin antikoru (Anti-Tg) değerlerine bakıldı. Hastalara 50-250 mCi (ortalama 135 mCi) aralığında RAİ tedavisi verildi. Tedavinin 7. gününde TVT yapıldı.BULGULAR: Toplam incelenen 483 hastadan tedavi öncesi TSH >30 IU/ml olan 431 hasta çalışmaya dahil edildi. TVT (+) olan 373 hastanın 243’ünde Tg (+) olarak bulundu. 373 hastanın 28’inde uzak metastaz tespit edildi. TVT (-) 58 hastanın 13'ünde Tg (+) olarak bulundu. PET/BT'de bu 13 hastanın 2'sinde uzak metastaz gözlendi. 431 hastanın 107’sinde (% 24) TVT (+) olmasına rağmen serum Tg seviyesi gerçek negatif olarak (Tg <2 ng/ml ve AntiTg <100 U/ml) tespit edilmiştir. Bu hastalardan birinde uzak metastaz saptanırken, diğer hastalarda rezidü ve/veya servikal lenfatik metastaz mevcuttu.SONUÇ: Bulgularımız DTK’inde Tg ölçümünün rezidü doku ve/veya servikal lenfatik metastazını ortaya koymada yetersizliğini göstermektedir. TVT’nin özellikle boyun bölgesindeki rezidü ve/veya lenfatik metastazları tespit ve lokalize etmede tamamlayıcı rolü olduğunu düşünmekteyiz.

Anahtar Kelimeler:

Diferansiye tiroid kanseri, Tiroglobulin, Tüm vücut tarama

COMPARISON OF THE WHOLE BODY SCAN AND THYROGLOBULIN IN DETERMINING THE RESIDUE AND METASTASIS IN DIFFERENTIAL THYROID CANCER

OBJECTIVE: In our study, we compare the importance of thyroglobulin (Tg) and post-treatment whole body scanning (WBS) scintigraphy in detecting residual and/or metastasis in patients with differentiated thyroid cancer (DTC) receiving radioactive iodine (RAI) treatment.MATERIAL AND METHODS: The files of the patients who underwent total or near-total thyroidectomy surgery, who were diagnosed with DTC and subsequently received RAI ablation, were retrospectively reviewed. L-Thyroxine treatment was discontinued to the patients before the RAI treatment and an iodine-poor diet was given to them for 14 days. Serum TSH level was ensured to be higher than 30 IU / ml before treatment. Serum TSH, Tg, and thyroglobulin antibody (Anti-Tg) values were measured before ablation therapy. RAI treatment was given to the patients in the range of 50-250 mCi (mean 135 mCi). WBS was performed on the 7th day of the treatment.RESULTS: Of the 483 patients examined in total, 431 patients with TSH> 30 IU / ml before treatment were included in the study. It was seen as Tg (+) in 243 of 373 patients with WBS (+), and distant metastasis was detected in 28 of these patients. In 13 of 58 patients with WBS (-), it was evaluated as Tg (+). Although 107 (24%) of 431 patients had WBS (+), serum Tg level was found to be true negative (Tg <2 ng/ml and AntiTg <100 U/ml). Distant metastasis was detected in one of these patients, while other patients had residual and / or cervical lymphatic metastasis.CONCLUSIONS: Our findings show that Tg measurement is insufficient to reveal residual tissue and / or cervical lymphatic metastasis in patients with DTC. This study suggests that WBS has a complementary role in detecting and localizing residual and / or lymphatic metastases, especially in the neck area.

Keywords:

Differentiated thyroid cancer, Thyroglobulin, Whole body scanning,

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