Comparison of whole body 131Iodine scan results in four, seven and nine days after radio-iodine therapy of differentiated thyroid cancer

Document Type: Original Article

Authors

Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: Finding optimum time of post ablation whole body iodine scan in patients with differentiated thyroid cancer(DTC) treated with I-131.
Material and Methods: 20 patients with DTC, who were treated with I131 underwent post ablation whole body iodine scan (WBIS) in days 4, 7 and 9 after treatment. A dual head gamma camera (e-cam, Siemens) equipped with high energy parallel hole collimator was used for imaging. The images were acquired with 7cm/min and stored in a 1024 ×256 matrix.
Results: 3 Patients had negative WBIS in all three sets of imaging and 17 patients had postsurgical thyroid remnants on all 3 scans. On days 4 and 7 we detected 11 patients with cervical lymph node metastases while on day 9 only 9 patients showed cervical lymph node metastases.(P=0.135)
On all 3 sets of images, we encountered 4 patients with mediastinal lymph node metastases and 1 patient with bone metastasis. In addition, all 3 sets of images detected lung metastases in three patients. The total number of affected foci did not have any statistical differences in whole body scan of day 4, 7 and 9. (P = 0.083)
Conclusion: According to the radiation safety hazards for staff and technicians of nuclear medicine department and lack of difference in scan findings between 4 and 7 days after RAI, scanning the DTC patients in the day 7 after RAI administration , is more practicable, with less probability of missing the sites of involvement. Performing whole body iodine scans after 1 week is not recommended.

Keywords


1. Li N, Du XL, Reitzel LR, Xu L, Sturgis EM. Impact of enhanced detection on the increase in thyroid cancer incidence in the United States: review of incidence trends by socioeconomic status within the surveillance, epidemiology, and end results registry, 1980–2008. Thyroid. 2013; 23(1):103-10.
2. Luster M, Clarke SE, Dietlein M, Lassmann M, Lind P, Oyen WJ, et al. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2008; 35(10):1941-59.
3. Chen AY, Jemal A, Ward EM. Increasing incidence of differentiated thyroid cancer in the United States, 1988-2005. Cancer. 2009; 115(16):3801-7.
4. Kent WD, Hall SF, Isotalo PA, Houlden RL, George RL, Groome PA. Increased incidence of differentiated thyroid carcinoma and detection of subclinical disease. CMAJ. 2007; 177(11):1357-61.
5. Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol. 2013; 2013:965212.
6. Aghaei A, Ayati N, Shafiei S, Abbasi B, Zakavi SR. Comparison of treatment efficacy 1 and 2 years after thyroid remnant ablation with 1110 versus 5550 MBq of iodine-131 in patients with intermediate-risk differentiated thyroid cancer. Nucl Med Commun. 2017; 38(11):927-31.
7. Schmidbauer B, Menhart K, Hellwig D, Grosse J. Differentiated thyroid cancer-treatment: state of the art. Int J Mol Sci. 2017; 18(6):E1292.
8. Carhill AA, Litofsky DR, Ross DS, Jonklaas J, Cooper DS, Brierley JD, et al. Long-term outcomes following therapy in differentiated thyroid carcinoma: NTCTCS registry analysis 1987-2012. J Clin Endocrinol Metab. 2015; 100(9):3270-9.
9. Jonklaas J, Sarlis NJ, Litofsky D, Ain KB, Bigos ST, Brierley JD, et al. Outcomes of patients with differentiated thyroid carcinoma following initial therapy. Thyroid. 2006; 16(12):1229-42.
10. Tuttle RM. Differentiated thyroid cancer: Radioiodine treatment. Waltham MA: UpToDate; 2016.
11. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994; 97(5):418-28.
12. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009; 19(11):1167-214.
13. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006; 16(2):109-42.
14. Haugen BR, Sawka AM, Alexander EK, Bible K, Caturegli P, Doherty G, et al. American thyroid association guidelines on the management of thyroid nodules and differentiated thyroid cancer task force review and recommendation on the proposed renaming of encapsulated follicular variant papillary thyroid carcinoma without invasion to noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Thyroid. 2017;27(4):481-3.
15. Fatourechi V, Hay ID, Mullan BP, Wiseman GA, Eghbali-Fatourechi GZ, Thorson LM, et al. Are posttherapy radioiodine scans informative and do they influence subsequent therapy of patients with differentiated thyroid cancer? Thyroid. 2000; 10(7):573-7.
16. Ronga G, Fiorentino A, Paserio E, Signore A, Todino V, Tummarello MA, et al. Can iodine-131 wholebody scan be replaced by thyroglobulin measurement in the post-surgical follow-up of differentiated thyroid  carcinoma. J Nucl Med. 1990;31(11):1766-71.
17. Schlumberger M. Can iodine-131 whole-body scan be replaced by  thyroglobulin measurement in the post-surgical follow-up of differentiated thyroid carcinoma? J Nucl Med. 1992; 33(1):172-3.
18. Hung BT, Huang SH, Huang YE, Wang PW. Appropriate time for post-therapeutic I-131 whole body scan. Clin Nucl Med. 2009; 34(6):339-42.
19. Castro MR, Bergert ER, Goellner JR, Hay ID, Morris JC.  Immunohistochemical analysis of sodium iodide symporter expression in metastatic differentiated thyroid cancer: correlation with radioiodine uptake.J Clin Endocrinol Metab. 2001; 86(11):5627-32.
20. Wang S, Liang J, Lin Y, Yao R. Differential expression of the Na+/I‑ symporter protein in thyroid cancer and adjacent normal and nodular goiter tissues. Oncol Lett. 2013; 5(1):368-72.