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- Title
Preablation 131-I scans with SPECT/CT in postoperative thyroid cancer patients: what is the impact on staging?
- Authors
Avram, Anca M; Fig, Lorraine M; Frey, Kirk A; Gross, Milton D; Wong, Ka Kit
- Abstract
<bold>Context: </bold>The utility of preablation radioiodine scans for the management of differentiated thyroid cancer remains controversial. <bold>Objective: </bold>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. <bold>Design: </bold>Prospective sequential series at university clinic. <bold>Methods: </bold>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. <bold>Results: </bold>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. <bold>Conclusions: </bold>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.
- Publication
Journal of Clinical Endocrinology & Metabolism, 2013, Vol 98, Issue 3, p1163
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/jc.2012-3630