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Intraoperative Assessment of Resection Margins in Oral Cavity Cancer: This is the Way

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Published on: May 10, 2021

Remnant uptake as a postoperative oncologic quality indicator.

David F Schneider¹, Kristin A Ojomo, Herbert Chen

¹Section of Endocrine Surgery, Department of Surgery, University of Wisconsin , Madison, Wisconsin.

Thyroid : Official Journal of the American Thyroid Association

|February 5, 2013

Summary

Postoperative radioiodine remnant uptake is a key indicator for differentiated thyroid cancer (DTC) recurrence. Higher uptake to dose ratios (UDR) predict recurrence, while high-volume surgeons achieve lower UDRs and fewer complications.

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Area of Science:

Endocrinology
Oncology
Nuclear Medicine

Background:

Differentiated thyroid cancer (DTC) management involves total thyroidectomy and radioactive iodine (RAI) treatment.
Postoperative radioiodine scans assess remnant uptake, but its oncologic significance requires further elucidation.

Purpose of the Study:

To evaluate the utility of remnant uptake on postoperative radioiodine scans as an oncologic indicator in differentiated thyroid cancer (DTC).
To determine if remnant uptake predicts disease recurrence after thyroidectomy and radioactive iodine (RAI) treatment.

Main Methods:

Retrospective review of 223 patients undergoing total thyroidectomy for DTC and RAI treatment.
Analysis of remnant uptake as an uptake to dose ratio (UDR) to standardize for varying RAI doses.
Multivariate logistic regression to assess the association between UDR and recurrence, controlling for other factors.

Main Results:

Patients with recurrence had a 10-fold higher UDR compared to those without recurrence (0.030 vs. 0.003, p=0.001).
Higher UDRs correlated with increasing postoperative thyroglobulin levels.
High-volume surgeons demonstrated significantly smaller UDRs (0.003 vs. 0.025, p=0.002) and fewer complications compared to low-volume surgeons.

Conclusions:

Remnant uptake, quantified by UDR, is a valuable postoperative indicator for differentiated thyroid cancer (DTC).
UDR effectively predicts the risk of disease recurrence and can signify the completeness of surgical resection.
Surgeon volume impacts UDR and complication rates, highlighting the importance of surgical expertise.