The Value of Pre-Ablative I-131 Scan for Clinical Management in Patients With Differentiated Thyroid Carcinoma

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Abstract

Background

A diagnostic I-131 (Dx) scan is used to detect a thyroid remnant or metastases before treatment of differentiated thyroid cancer (DTC) with I-131. The aim of this study is to specify in which patients with DTC a Dx scan could have an additional value, by studying the effect of the Dx scan on clinical management.

Methods

Patients with DTC, treated with I-131 after thyroidectomy were included in this retrospective cohort study. Twenty-four hours after administration of 37 MBq I-131 a whole body Dx scan and an uptake measurement at the original thyroid bed were performed. Outcomes of the Dx scan and the subsequent changes in clinical management, defined as additional surgery or adjustment of I-131 activity, were reported. Risk factors for a change in clinical management were identified with a binary logistic regression.

Results

In 11 (4.2%) patients clinical management was changed, including additional surgery (n=5), lowering I-131 activity (n=5) or both (n=1). Risk factors for a change in clinical management were previous neck surgery (OR 5.9, 95% CI: 1.4-24.5), surgery in a non-tertiary center (OR 13.4, 95% CI: 2.8 - 63.8), TSH = 50.0 ng/L (OR 7.4, 95% CI: 1.6-34.9) and free T4 >= 4.75 pmol/L (OR 156.8, 95% CI: 128.4-864.2)

Conclusion

The Dx scan can potentially change clinical management before treatment with I-131, but the yield is low. A Dx-scan should only be considered for patients with a high pre-scan risk of a change in management, based on patient history and prior center-based surgical outcomes.

Original languageEnglish
Article number655676
Number of pages7
JournalFrontiers in endocrinology
Volume12
DOIs
Publication statusPublished - 28-May-2021

Keywords

  • postoperative I-131 diagnostic scan
  • differentiated thyroid carcinoma
  • uptake
  • clinical management
  • thyroid cancer
  • PREABLATION 131-I SCANS
  • ASSOCIATION GUIDELINES
  • CANCER
  • THERAPY
  • SURGEON
  • VOLUME
  • SPECT/CT
  • OUTCOMES
  • NODULES
  • UTILITY

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