Endocrinol Metab.  2019 Mar;34(1):63-69. 10.3803/EnM.2019.34.1.63.

(99m)Tc-Pertechnetate Scintigraphy Predicts Successful Postoperative Ablation in Differentiated Thyroid Carcinoma Patients Treated with Low Radioiodine Activities

• Giovanella L
• Paone G
• Ruberto T
• Ceriani L
• Trimboli P

• KMID: 2441680
• DOI: http://doi.org/10.3803/EnM.2019.34.1.63

Abstract

BACKGROUND
Postoperative routine radioiodine (RAI) treatment is currently debated for patients with low-risk differentiated thyroid carcinoma (DTC) patients. If performed, a low 131I activity (i.e., 1 to 2 GBq) is recommended with the aim to ablate thyroid remnant and facilitate subsequent follow-up by thyroglobulin measurement. The purpose of this study was to evaluate the relationship between postsurgical technetium-99m (99mTc)-pertechnetate scintigraphy and the rate of successful remnant ablation after low activity radioiodine ablation in patients with DTC.
METHODS
Enrolled were 193 patients with low risk DTC who underwent total thyroidectomy and RAI ablation with a fixed 1.1 GBq activity of 131I. 99mTc-pertechnetate scans were done and thyrotropin stimulated thyroglobulin (sTg) levels measured just before ablation. Ablation effectiveness was assessed 6 to 12 months later by sTg measurement, neck ultrasound and diagnostic whole body scan.
RESULTS
A negative 99mTc-perthecnetate scans was the best predictor of successful ablation (P<0.001) followed by preablative sTg levels <0.8 ng/mL (P=0.008) and 99mTc-pertechnetate uptake rate values <0.9% (P=0.065). Neither sex nor age of the patient at the time of ablation or tumor histology and size showed a significant association with the rate of successful ablation.
CONCLUSION
The 99mTc-pertechnetate scintigraphy is a simple and feasible tool to predict effectiveness of low activity 131I thyroid to ablate thyroid remnants in patients with DTC.

Keyword

Differentiated thyroid carcinoma; Radioiodine; Radionuclide imaging; Sodium pertechnetate Tc 99m

MeSH Terms

Follow-Up Studies
Humans
Neck
Radionuclide Imaging*
Sodium Pertechnetate Tc 99m
Thyroglobulin
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy
Thyrotropin
Ultrasonography
Whole Body Imaging
Sodium Pertechnetate Tc 99m
Thyroglobulin
Thyrotropin

Figure

• 

  Fig. 1 Postoperative technetium-99m (99mTc)-pertechnetate scintigraphy (A) showing multiple uptake foci (arrows) (uptake rate 1.3%), whole body scan (WBS) with additional single photon emission computed tomography/computed tomography, (B) showing a corresponding intensely iodine-avid remnants (arrows), and (C) diagnostic WBS performed 6 months later showing two areas of persisting faint uptake (arrows) in a 47 years old woman with papillary thyroid carcinoma pT2pN0 (preablation stimulated thyroglobulin, 4.4 ng/mL; response assessment: basal [0.4 ng/mL] and stimulated [1.2 ng/mL] thyroglobulin, respectively). Response assessment: unsuccessful ablation.

• 

  Fig. 2 Postoperative technetium-99m (99mTc)-pertechnetate scintigraphy (A) with no visually discernable neck uptake, whole body scan (WBS) with additional single photon emission computed tomography/computed tomography, (B) showing a iodine-avid remnant, and (C) diagnostic WBS performed 6 months later showing complete ablation in a 32 years old female with papillary thyroid carcinoma pT2pNx (stimulated thyroglobulin: preablation, 1.2 ng/mL; response assessment <0.15 ng/mL). Response assessment: successful ablation.

• 

  Fig. 3 Receiving Operator Characteristics curve analysis for preablation technetium-99m (99mTc)-pertechnetate uptake rate (A) and stimulated thyroglobulin (sTg) (B) to predict successful ablation. The optimal cutoffs (arrows) were 0.9% (sensitivity 70%, specificity 55%; area under the curve, 0.710; P=0.020) and 0.8 ng/mL (sensitivity 65%, specificity 67%; area under the curve, 0.620; P=0.025) for predicting successful routine radioiodine ablation.

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