Recurrent/metastatic thyroid carcinomas false negative for serum thyroglobulin but positive by posttherapy I-131 whole body scans |
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Authors: | Eun-Kyung Park June-Key Chung Il Han Lim Do Joon Park Dong Soo Lee Myung Chul Lee Bo Youn Cho |
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Affiliation: | (1) Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-Gu, Seoul, 110-744, Korea;(2) Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea;(3) Medical Research Center of Tumor Immunity, Seoul National University College of Medicine, Seoul, Korea;(4) Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea |
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Abstract: | Purpose Serum Tg and I-131 WBS have been used to detect recurrent and metastatic thyroid cancers postoperatively. Tg is known to be
more sensitive than I-131 WBS, and therefore, false-negative WBS cases with elevated Tg levels are frequently found. However,
the clinical characteristics of false-negative Tg cases with positive WBS have not been clarified.
Materials and methods The authors evaluated 824 postoperative patients with differentiated thyroid carcinoma who underwent post-ablation/therapy
I-131 WBS. Tg negativity was defined as a Tg level of ≤2 ng/mL without TgAb under thyroid-stimulating hormone stimulation.
Remission, recurrence, and metastasis were confirmed using pathologic or clinically findings.
Results Fifty-two patients (6.3%) with functioning metastasis and negativity for TgAb were Tg-negative and posttherapy I-131 WBS-positive
(TgN group), and 128 patients with functioning metastases were Tg positive and WBS positive (TgP group). The TgN group consisted
of 45 cases of cervical/mediastinal lymph node metastases (86.5%) and seven cases of distant metastasis to lung or bone by
follow-up WBS. The TgN group demonstrated significantly higher profiles of regional involvement than the TgP group (P < 0.029). In 47 patients in the TgN group, metastatic uptake disappeared in 33, ameliorated in four, and persisted in ten
during follow-up.
Conclusions A significant number of differentiated thyroid cancer patients were Tg-/TgAb-negative despite a positive WBS finding. Cervical
and mediastinal lymph nodes were predominant sites of metastasis in the TgN group. WBS should be undertaken routinely as a
complementary modality to detect functioning recurrence and metastasis regardless of serum Tg results. |
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Keywords: | Differentiated thyroid carcinoma Thyroglobulin I-131 whole body scan Recurrence Metastasis |
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