Background: Differentiated thyroid carcinoma (DTC) is a malignant tumor of epithelial origin. Initial treatment consists of total thyroidectomy and radioiodine ablation with 131I. The follow-up, is clinical, laboratoristic and with neck ultrasound, and the key point to define disease remission is rhTSH-Tg test. The recent introduction of UsTg and high resolution US seems to be able to modify the algorithms of follow-up of these patients. Methods: We evaluated data of 505 patients with DTC at the time of remnant ablation (30 mCi of 131I after rhTSH) and during the following 12 months, with anti-thyroglobulin antibodies (TgAb) <20 U/ml. We excluded from our study "very low” and “high” risk DTC patients. The aim was to evaluate which parameters could have a predictive value for remission/persistence of disease in a short-term follow-up. Results: In a multivariate analysis, only values of UsTg-LT4 >1 ng/ml (p 0,000) and the presence of lymphnodes metastases at the US examinations (p 0,000), at the moment of remnant ablation, were correlated significantly with persistence of the disease after 12 months. At the contrary, low TgUs-LT4 values (<0,1) and absence of lymphnode metastases seems to have a positive predictive value for the remission of disease after 1 year. All other epidemiological and clinicopathological parameters considered (age, initial histology, staging, lymph node metastases at the histology, prophylactic dissection of the central compartment, multifocality, TNM, staging) showed no statistical significance. Conclusions: 1) LT4-TgUs values and Neck US at the time of remnant ablation, are good prognostic factors of remission/persistence of disease in a short follow up; 2) Other parameters analyzed don't seem to have a prognostic role in our series; 3) In the near future, low and intermediate risk pts could be avoided radioiodine ablation and be only followed with clinical, laboratoristic and ultrasonographyc controls.
Predictive Value Of High Sensitive Thyroglobulin Assay (USTG) And Neck Ultrasonography (US) At The Time Of Remnant Ablation On Lt-4 Therapy In Patients With Low And Intermediate Risk Differentiated Thyroid Cancer (DTC)
Matrone A.;Gambale C.;Molinaro E.;Agate L.;Bottici V.;Biagini A.;Viola D.;Vitti P.;Elisei R.
2014-01-01
Abstract
Background: Differentiated thyroid carcinoma (DTC) is a malignant tumor of epithelial origin. Initial treatment consists of total thyroidectomy and radioiodine ablation with 131I. The follow-up, is clinical, laboratoristic and with neck ultrasound, and the key point to define disease remission is rhTSH-Tg test. The recent introduction of UsTg and high resolution US seems to be able to modify the algorithms of follow-up of these patients. Methods: We evaluated data of 505 patients with DTC at the time of remnant ablation (30 mCi of 131I after rhTSH) and during the following 12 months, with anti-thyroglobulin antibodies (TgAb) <20 U/ml. We excluded from our study "very low” and “high” risk DTC patients. The aim was to evaluate which parameters could have a predictive value for remission/persistence of disease in a short-term follow-up. Results: In a multivariate analysis, only values of UsTg-LT4 >1 ng/ml (p 0,000) and the presence of lymphnodes metastases at the US examinations (p 0,000), at the moment of remnant ablation, were correlated significantly with persistence of the disease after 12 months. At the contrary, low TgUs-LT4 values (<0,1) and absence of lymphnode metastases seems to have a positive predictive value for the remission of disease after 1 year. All other epidemiological and clinicopathological parameters considered (age, initial histology, staging, lymph node metastases at the histology, prophylactic dissection of the central compartment, multifocality, TNM, staging) showed no statistical significance. Conclusions: 1) LT4-TgUs values and Neck US at the time of remnant ablation, are good prognostic factors of remission/persistence of disease in a short follow up; 2) Other parameters analyzed don't seem to have a prognostic role in our series; 3) In the near future, low and intermediate risk pts could be avoided radioiodine ablation and be only followed with clinical, laboratoristic and ultrasonographyc controls.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
