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Departments of Nuclear Medicine and Endocrine Tumors, Surgery, Institut Gustave Roussy, Villejuif, France 94805
Address all correspondence and requests for reprints to: M. Schlumberger, Institut Gustave Roussy and University Paris-Sud, 39, Rue Camille-Desmoulins, 94 805 Villejuif Cedex, France. E-mail: schlumbg{at}igr.fr.
The follow-up of patients with papillary and follicular thyroid carcinoma after thyroidectomy and radioiodine ablation is mainly based on serum thyroglobulin (Tg) level deter-mination.
The positive predictive value (PPV) of serum Tg level after thyroid hormone withdrawal, measured during the first 6–12 months of follow-up (initial off L-T4 Tg), was studied in 256 consecutive differentiated thyroid cancer patients. All underwent a total thyroidectomy and 3.7 GBq 131I ablation; 37 patients had an elevated initial off L-T4 Tg level. This study focuses on these 37 patients, 9 of whom had a clinical recurrence.
The present data confirm that in this selected cohort of patients, 74–185 MBq 131I-total body scan (TBS) has no clinical interest in the initial work-up and during the subsequent follow-up because it was negative in all patients, except in one with recurrent disease. The PPV of initial serum off L-T4 Tg level above 5 ng/ml and 10 ng/ml was 42% and 53%, respectively; this PPV was only 50% at the time of recurrence or subsequent control. This relatively low PPV is related to the low recurrence rate in this series of patients, despite a prolonged follow-up, and to the subsequent decrease of serum Tg level in 14 of 37 (38%) patients in the absence of any further treatment. In contrast, the PPV of the increasing slope of serum Tg levels obtained after thyroid hormone withdrawal (83%) was excellent.
In conclusion, we confirm that 131I-TBS has a limited interest for the follow-up of thyroid cancer patients. Follow-up should rely on serum Tg level and prognostic parameters; however, initial serum Tg may be produced by thyroid tissues of various significance, an increase at two consecutive determinations indicating disease progression and a decrease being related to late effects of therapy. The best PPV is brought by the slope of serum Tg levels.
Abbreviations: CI, Confidence interval(s); PPV, positive predictive value; TBS, total body scan; Tg, thyroglobulin.
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