Role of the 131I whole body scan for initial follow-up in patients with intermediate-risk differentiated thyroid cancer
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Abstract
A combination of diagnostic whole body scan (DxWBS), neck ultrasound, and serum stimulated thyroglobulin (stim-Tg) is now recommended for the initial follow-up in patients with intermediate-risk differentiated thyroid cancer (DTC). However, previous studies demonstrated the low additional value of DxWBS for the detection of persistent disease. This study aimed to determine the necessity of using DxWBS for the initial follow-up of these patients. This retrospective analytical study included 126 patients with intermediate-risk DTC (according to 2015 ATA guidelines) after total thyroidectomy and received the first 131I treatment. All patients underwent stim-Tg, neck ultrasound, and DxWBS at about 6–12 months after 131I treatment. Persistent disease was defined as uptake outside the thyroid bed from DxWBS, uptake within the thyroid bed from DxWBS, or an abnormal ultrasound finding with cytologically or pathologically proven persistent disease, positive for serum anti-thyroglobulin antibody (TgAb), or stim-Tg of 1 ng/mL or more. The percentage difference for detection of persistent disease when using only neck ultrasound with stim-Tg compared to a combination with DxWBS was calculated. We considered non-inferior when the percentage difference is below five. Of the 126 patients with intermediate-risk DTC, persistent diseases were detected in 85 patients and identified by DxWBS, neck ultrasound, and stim-Tg in 24, 14, and 77 patients, respectively. Combined neck ultrasound and stim-Tg could detect persistent disease in 78 patients. Although using only neck ultrasound and stim-Tg could detect 8.2% (95%CI: 1.2 to 15.3) of patients with persistent disease less than that compared with using combined all three modalities, all patients with only positive DxWBS showed thyroid remnants, not the true persistent disease. These findings indicated that DxWBS may not be necessary for initial follow-up in patients with intermediate-risk DTC.
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