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Anca M. Avram, Lorraine M. Fig, Kirk A. Frey, Milton D. Gross, Ka Kit Wong, Preablation 131-I Scans With SPECT/CT in Postoperative Thyroid Cancer Patients: What Is the Impact on Staging?, The Journal of Clinical Endocrinology & Metabolism, Volume 98, Issue 3, 1 March 2013, Pages 1163–1171, https://doi.org/10.1210/jc.2012-3630
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The utility of preablation radioiodine scans for the management of differentiated thyroid cancer remains controversial.
To determine the contribution of preablation Iodine 131 (131-I) planar with single-photon emission computed tomography/computed tomography (SPECT/CT; diagnostic [Dx] scans) to differentiated thyroid cancer staging.
Prospective sequential series at university clinic.
Using American Joint Committee on Cancer (AJCC) tumor, node, metastasis (TNM) staging, seventh edition 320 patients post–total thyroidectomy were initially staged based on clinical and pathology data (pTN) and then restaged after imaging (TNM). The impact of Dx scans with SPECT/CT on N and M scores, and TNM stage, was assessed in younger, age <45 years, n = 138 (43%), and older, age ≥45 years, n = 182 (57%) patients, with subgroup analysis for T1a and T1b tumors.
In younger patients Dx scans detected distant metastases in 5 of 138 patients (4%), and nodal metastases in 61 of 138 patients (44%), including unsuspected nodal metastases in 24 of 63 (38%) patients initially assigned pathologic (p) N0 or pNx. In older patients distant metastases were detected in 18 of 182 patients (10%), and nodal metastases in 51 of 182 patients (28%), including unsuspected nodal metastases in 26 of 108 (24%) patients initially assigned pN0 or pNx. Dx scans detected distant metastases in 2 of 49 (4%) T1a, and 3 of 67 (4.5%) T1b patients.
Dx scans detected regional metastases in 35% of patients, and distant metastases in 8% of patients. Information acquired with Dx scans changed staging in 4% of younger, and 25% of older patients. Preablation scans with SPECT/CT contribute to staging of thyroid cancer. Identification of regional and distant metastases prior to radioiodine therapy has significant potential to alter patient management.
