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在差异化甲状腺癌中随访诊断放射性扫描的价值

Teresa Kraus¹, Natalia Shengelia-de Lange², Holger Einspieler¹

¹Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.

Endocrine connections

|March 21, 2024

概括

对差异化甲状腺癌 (DTC) 的初始随访可能不需要对所有患者进行放射性全身扫描 (WBS). 低刺激性铁血球蛋白 (Tg) 水平 (<0.5 ng/mL) 与负WBS结果相关,这表明这些情况下可能不需要WBS.

科学领域:

内分泌学在内分泌学.
核医学就是核医学.
在瘤学瘤学.

背景情况:

分化甲状腺癌 (DTC) 的随访严重依赖于血清甲状腺蛋白 (Tg) 测量以检测复发.
目前ESMO和ATA的指导方针建议不同级别的随访,包括Tg测定,部超声波和潜在的放射性全身扫描 (WBS).
在DTC患者的初始随访中,特别是那些刺激Tg水平较低的患者中,常规诊断WBS的必要性受到质疑.

研究的目的:

评估在差异化甲状腺癌 (DTC) 患者的初始随访中诊断放射性全身扫描 (WBS) 的必要性.
确定低刺激性铁血球蛋白 (Tg) 水平与第一个随访期间诊断WBS的发现之间的相关性.
评估目前DTC的后续协议是否可以根据刺激的Tg水平进行改进.

主要方法:

对370名差异化甲状腺癌 (DTC) 患者的回顾性数据分析.
从2015年至2019年期间从维也纳和特比利斯的核医学部门从接受定期治疗和后期护理的患者收集的数据.
分析包括基础和刺激血清Tg水平,Tg抗体水平和诊断性放射性全身扫描 (WBS) 结果.

主要成果:

观察到低刺激Tg水平 (<0.5 ng/mL) 和第一个随访时的负诊断WBS结果 (χ2 = 14.7,P < 0.001) 之间存在高度显著的关系.
在370名患者中,8.4% (31名患者) 在诊断WBS方面取得了积极的结果.
19.74% (75名患者) 刺激的Tg水平大于0.5 ng/mL.

结论:

对于DTC的初始随访 (治疗后4-12个月),包括基底和刺激Tg水平和Tg抗体测量,可能不需要对所有患者进行诊断WBS.
低刺激Tg水平 (<0.5 ng/mL) 与负面WBS发现有很强的关联,这表明诊断程序的潜在降级.
这些发现支持对DTC后续更为量身定制的方法,可能减少在选定的患者群体中需要例行WBS的需要.

关键词:

诊断性放射性全身扫描扫描后续行动后续行动甲状腺球蛋白甲状腺球蛋白甲状腺癌是一种癌症.

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