Preoperative Use of Intravenous Contrast Media Is Associated With Decreased Excellent Response Rates in Intermediate-Risk DTC Patients Who Subsequently Receive Total Thyroidectomy and Low-Dose RAI Therapy.

Purpose: To evaluate the impact of preoperative use of intravenous contrast media (ICM) on the excellent response (ER) rates in a cohort of intermediate-risk differentiated thyroid cancer (DTC) patients who received total thyroidectomy (TT) and low-dose radioactive iodine (RAI) therapy. Methods: A total of 683 consecutive patients were retrospectively reviewed in a single center between August 2016 and August 2018. Patients were divided into ICM group (n = 532) and non-ICM group (n = 151). Intravenous contrast media patients were 1:1 propensity matched to non-ICM patients based on T stage, N stage, and urinary iodine. Risk-adjusted logistic regression models were constructed to assess the association between the use of ICM and ER rates. Results: Intravenous contrast media patients had significantly higher T stage (P < 0.001), N stage (P < 0.001), urinary iodine (P < 0.001), and ps-Tg (P = 0.042) than non-ICM patients. Preoperative use of ICM was found to be significantly associated with decreased ER rates in both the primary cohort [odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.32-0.71; P < 0.001] and the matched cohort (OR = 0.48, 95% CI = 0.25-0.94; P = 0.031). Subgroup analysis on RAI delay time in the primary cohort revealed that ER rates in ICM patients were significantly lower than that of non-ICM patients for 1-2 months (P = 0.0245) and >2-3 months (P = 0.0221) subgroups, but not for >3-4 months, >4-5 months, and >5-6 months subgroups (all P > 0.05). A delay time of >3-4 months exhibited the highest ER rate (63.08%) within the ICM group. Conclusions: Preoperative use of ICM is associated with decreased ER rates in intermediate-risk DTC patients who subsequently receive TT and low-dose RAI therapy. For such patients, if ICM has already been received, an RAI delay time of >3-4 months would seem to be more appropriate to achieve better ER rates.

Diagnostic performance of 18F-FDG-PET/CT in DTC patients with thyroglobulin elevation and negative iodine scintigraphy: a meta-analysis.

PURPOSE: To evaluate the accuracy of 18F-FDG-PET/CT for the detection of recurrent and/or metastatic diseases in differentiated thyroid cancer (DTC) patients with thyroglobulin elevation and negative iodine scintigraphy. Whether PET/CT with TSH stimulation (sPET/CT) had better diagnostic performance than PET/CT without TSH stimulation (nsPET/CT) in this scenario was also evaluated. METHODS: PubMed and Embase databases were searched for eligible studies from January 2001 to December 2018. Only studies with clearly stated reference standard (histopathology confirmation and/or clinical/imaging follow-up) were included. Publication bias was assessed by Deeks funnel plot. The pooled sensitivity, specificity, diagnostic odds ratio (DOR) and the area under the summary receiver-operating characteristics curve (AUC) for PET/CT was determined by random-effect analysis, respectively. sPET/CT and nsPET/CT were compared pairwise for all diagnostic estimate indexes using Z-test. RESULTS: We included 17 studies with 1195 patients in this meta-analysis. The pooled sensitivity, specificity, DOR and AUC for PET/CT on patient-based data were 0.86 (95% CI: 0.79-0.91), 0.84 (95% CI: 0.72-0.91), 31.00 (95% CI: 12.00-80.00) and 0.91 (95% CI: 0.88-0.93), respectively. There was high heterogeneity (I 2 = 80% for sensitivity, I 2 = 82% for specificity) and possible publication bias (P = 0.01). Z test did not detect statistically significant difference between sPET/CT and nsPET/CT for all the diagnostic estimate indexes (all P > 0.05). CONCLUSIONS: On patient-based analysis, 18F-FDG-PET/CT has high diagnostic accuracy for the detection of recurrent and/or metastatic diseases in DTC patients with thyroglobulin elevation and negative iodine scintigraphy, but existing studies were limited by high heterogeneity and possible publication bias. The diagnostic performance of sPET/CT may be not superior to nsPET/CT.

Negative remnant 99mTc-pertechnetate uptake predicts excellent response to radioactive iodine therapy in low- to intermediate-risk differentiated thyroid cancer patients who have undergone total thyroidectomy.

OBJECTIVE: Negative 99mTc-pertechnetate uptake of the thyroid bed indicates the absence or a small volume of remnant thyroid tissue (RTT) after total thyroidectomy (TT). The aim of this study is to evaluate the predictive value of negative 99mTc-pertechnetate scintigraphy for excellent response (ER) to radioactive iodine therapy (RIT) in low- to intermediate-risk differentiated thyroid cancer (DTC) patients. PATIENTS: One-hundred and eighty-nine low- to intermediate-risk DTC patients who underwent TT, RIT with a single dose of 30 mCi and suppressive therapy with thyroid-stimulating hormone (TSH) from July 2015 to February 2016 in our hospital were retrospectively evaluated. 99mTc-pertechnetate thyroid scintigraphy was performed just before RIT and images were reported dichotomously as negative or positive. The response of patients was assessed for 23.2 ± 3.8 months after RIT and dichotomized as excellent response (ER) or non-excellent response (NER). 99mTc-pertechnetate uptake, age at diagnosis, gender, multifocality, T stage, N stage, preablative stimulated thyroglobulin (ps-Tg), and TSH were explored as potential predictors for ER. RESULTS: 80.68% (71/88) of patients with negative 99mTc-pertechnetate uptake achieved ER. When patients were evaluated according to different ps-Tg levels, we found that 94.83% (55/58) of patients with ps-Tg < 1 ng/ml and negative 99mTc-pertechnetate uptake achieved ER. Multivariate Cox regression analysis revealed that ps-Tg (P = 0.0001) and 99mTc-pertechnetate uptake (P = 0.0473) were independent predictors for ER. CONCLUSIONS: In addition to ps-Tg, negative 99mTc-pertechnetate uptake is also a significant independent predictor for an excellent response in low- to intermediate-risk patients. It may be possible to omit RIT in patients with ps-Tg < 1 ng/ml and concurrent negative 99mTc-pertechnetate uptake.

Indeterminate solitary vertebral lesions on planar scintigraphy.

OBJECTIVE: This study aims to evaluate the added value of hybrid SPECT-CT in differential diagnosis of indeterminate solitary vertebral lesion (SVL) on planar scintigraphy in patients with non-small cell lung cancer (NSCLC). METHODS: Sixty-three NSCLC patients with indeterminate "hot spot" SVL on planar scintigraphy were retrospectively included in this study. Pathological confirmation and followup by whole body scintigraphy and SPECT-CT were used as golden standard for the evaluation of diagnostic performance of planar scintigraphy, SPECT, and SPECT-CT. Receiver operating characteristic (ROC) analyses were performed and compared among the three imaging modalities. For subgroup analysis, the performance of each imaging modality in different NSCLC subgroups including age, gender, histology of primary tumor and nature, site and location of SVL were analyzed, respectively. The impact of SPECT-CT on the management of NSCLC patient with SVL was also analyzed. RESULTS: The sensitivity and specificity of planar scintigraphy, SPECT, and SPECT-CT in differentiating SVL were 41.9 % and 81.2 %, 83.9 % and 71.9 %, and 90.3 % and 90.6 %, respectively. SPECT-CT performed significantly better than both planar scintigraphy (P < 0.0001) and SPECT (P = 0.0027). The sensitivity for planar scintigraphy in nonlytic SVL was significantly higher than in lytic SVL (88.5 % vs. 50.0 %, P = 0.0008). The sensitivity for the planar scintigraphy and SPECT-CT in dorsal SVL was significantly higher than in non-dorsal SVL (55.0 % vs. 18.2 %, P = 0.0029 and 100 % vs. 85.7 %, P = 0.0236, respectively). SPECT-CT had an impact on the clinical management of 52.6 % (20/38) of patients compared to planar scintigraphy and 23.6 % (9/38) of patients compared to SPECT. CONCLUSION: Compared to planar scintigraphy and SPECT, hybrid SPECT-CT shows excellent performance in differentiating indeterminate SVL in NSCLC patients, the application of which will significantly impact patient management. ZIEL: : Ziel dieser Studie ist es, den Mehrwert der hybriden SPECT-CT in der Differenzialdiagnose der unbestimmten solitären Knochenläsionen der Wirbelsäule (SVL) auf der planaren Szintigraphie bei Patienten mit nichtkleinzelligem Lungenkarzinom (NSCLC) zu untersuchen. METHODE: Retrospektiv wurden 63 NSCLC-Patienten mit unbestimmten solitären "hot spot" Knochenläsionen der Wirbelsäule unter planarer Szintigraphie eingeschlossen. Pathologische Bestätigung und Follow-up durch Ganzkörper-Szintigraphie und SPECTCT wurden als Goldstandard für die Bewertung der diagnostischen Leistung der Planar- Szintigraphie, SPECT und SPECT-CT verwendet. ROC-Analysen (Receiver Operating Characteristic, Beobachterkennlinie) wurden erstellt und zwischen den drei Bildgebungsmodalitäten verglichen. Für die Subgruppenanalyse wurde die Leistung jeder Bildgebungsmodalität in verschiedenen NSCLC-Untergruppen einschließlich Alter, Geschlecht, Histologie des Primärtumors und der Art, Lage und Ort der SVL analysiert. Der Einfluss von SPECT-CT auf das Management von NSCLC-Patienten mit SVL wurde ebenfalls analysiert. ERGEBNISSE: Die Sensitivität und Spezifität der planaren Szintigraphie, SPECT und SPECT-CT bei der Differenzierung von SVL waren 41,9 % und 81,2 %, 83,9 % und 71,9 % bzw. 90,3 % und 90,6 %. Die SPECT-CT zeigte eine signifikant bessere Leistung als die planare Szintigraphie (P < 0,0001) und die SPECT (P = 0,0027). Die Sensitivität für die planare Szintigraphie bei nicht-lytischer SVL war signifikant höher als bei der lytischen SVL (88,5 % vs. 50,0 %, p = 0,0008). Die Sensitivität für die planare Szintigraphie und SPECT-CT in der dorsalen SVL war signifikant höher als in nicht-dorsalen SVL (55,0 % gegenüber 18,2 %, P = 0,0029 und 100 % gegenüber 85,7 %, P = 0,0236). SPECT-CT beeinflusste das klinische Management von 52,6 % (20/38) der Patienten im Vergleich zur planaren Szintigraphie und 23,6 % (9/38) der Patienten im Vergleich zur SPECT. SCHLUSSFOLGERUNG: Im Vergleich zur Planar-Szintigraphie und SPECT zeigt die hybride SPECT-CT eine hervorragende Leistung bei der Differenzierung unbestimmter SVL bei NSCLC-Patienten, deren Anwendung das Patientenmanagement signifikant beeinflussen wird.