Combination of Initial Stimulation Thyroglobulins and Staging System by Revised ATA Guidelines Can Elaborately Discriminate Prognosis of Patients With Differentiated Thyroid Carcinoma After High-Dose Remnant Ablation

• Published in: Clinical nuclear medicine 2012-11, Vol.37 (11), p.1069-1074
• Main Authors: Kim, Min-Hee, Ko, Sun Hee, Bae, Ja-Seong, Lim, Dong-Jun, Baek, Ki-Hyun, Lee, Jong-Min, Kang, Moo-Il, Cha, Bong-Yun
• Format: Article
• Language: English
• Subjects: Ablation Techniques; Cell Differentiation; Dose-Response Relationship, Radiation; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Neoplasm Staging; Practice Guidelines as Topic; Prognosis; Radionuclide Imaging; Risk Factors; Societies, Medical; Thyroglobulin - blood; Thyroid Neoplasms - blood; Thyroid Neoplasms - diagnostic imaging; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery
• ISSN: 0363-9762; 1536-0229
• DOI: 10.1097/RLU.0b013e318266d4a5

PURPOSEThe aim of this study was to evaluate prognostic role of thyroglobulin (Tg) levels at the time of ablation (A-Tg) and stimulation Tg levels at 6–12 months after remnant ablation (S-Tg) combined with revised American Thyroid Association (ATA) guidelines risk stratification. PATIENTS AND METHODSData of 359 patients (median follow-up duration66.3 months) with papillary thyroid carcinoma who had high-dose remnant ablation were analyzed. The cutoff value of A-Tg to predict the persistent/recurrent disease was calculated by receiver operating characteristic curve analysis. In each risk group by ATA guidelines, the association of A-Tg with persistent/recurrent disease was evaluated. The role of A-Tg and ATA risk stratification in each S-Tg group (group with S-Tg 10 ng/mL) was also evaluated. Tg response was determined by the difference between A-Tg and S-Tg with consideration of the dose of radioactive iodine ablation. RESULTSA-Tg above 5.22 ng/mL was associated with persistent/recurrent disease in all risk groups by ATA guidelines. A-Tg above the cutoff value and ATA risk assessment was related to persistent/recurrent disease in patients with S-Tg 2 to 10 ng/mL (P = 0.003) and S-Tg above 10 ng/mL (P = 0.019). However, no difference in the incidence of persistent/recurrent disease was found according to Tg response. The scoring system made up of A-Tg, S-Tg, and ATA staging showed elaborate discrimination of prognosis. CONCLUSIONRisk stratification using combined scoring with initial stimulated Tg levels, including A-Tg and S-Tg, and staging system by revised ATA guidelines can effectively predict persistent/recurrent disease in patients with papillary thyroid carcinoma.