Oral Presentation ESA-SRB-AOTA 2019

Lymph node metastases detection by serum thyroglobulin and neck ultrasonography, and long term follow up in patients with papillary or follicular thyroid cancer previously treated with radioiodine and/or surgery   (#150)

Poupak Fallahi 1 , Silvia Martina Ferrari 2 , Giusy Elia 2 , Ilaria Ruffilli 2 , Francesca Ragusa 2 , Sabrina Rosaria Paparo 2 , Gabriele Materazzi 3 , Paolo Miccoli 3 , Alessandro Antonelli 2
  1. Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
  2. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
  3. Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy

Our purpose was to assess the early detection of metastatic lateral neck lymph nodes (LNL) in patients with papillary or follicular differentiated thyroid cancer (DTC), and long-term follow-up after I131 and/or surgery treatment. Seventy hundred and ten patients were enrolled in the study and their LNL evaluation was made by thyroglobulin (Tg) measurement and neck ultrasonography (NU). These patients were affected by DTC and had been treated with a near-total thyroidectomy and I131 ablation of residual tissue, and subjected to follow-up by Tg measurement, NU, diagnostic and post-therapy whole body scan (WBS), alone or in combination. In the LNL detection the TSH-stimulated Tg alone had a sensitivity of 86%, and a negative predictive value (NPV) of 84%; whereas NU had a sensitivity of 70%, and NPV of 68%. The sensitivity reached the 98% by combining TSH-stimulated Tg plus NU, while the NPV reached the 96%.

In patients with LNL uptaking radioiodine and then subject to a I131 treatement, the following outcomes were reported: 49% responded after a median of 4 cycles (median 354 mCi, cumulative dose; 7.4 years median follow-up) with “disappearence of uptake at post-therapy WBS and Tg<1 ng/ml” (complete remission, CR); 12% of not responding cases had CR following other treatments. A treatment with surgery, and subsequent I131 readministration was made on LNL patients not uptaking or not responding to I131 (9%), who showed a CR in 23% of cases (6.5 years median follow-up).

To sum up, an early detection of LNL in DTC-patients could help in the achievement of a CR by I131 in 49% of them, after 4 or less I131 treatments. Combining different therapies could help patients not responder/not uptaking I131 to reach a CR in 24% of cases.