Presentation on theme: "Hong CM, Ahn BC, Jeong SY, Lee SW, Lee J"— Presentation transcript:
1Hong CM, Ahn BC, Jeong SY, Lee SW, Lee J AOTADiscovery Kartika Plaza Hotel, Bali, IndonesiaFate of Residual Cervical Metastatic Lymph nodes Found on I-131 Post-ablation SPECT/CT in Patients with Differentiated Thyroid CancerHong CM, Ahn BC, Jeong SY, Lee SW, Lee JDepartment of Nuclear MedicineKyungpook National UniversitySchool of Medicine & Hospital
2Metastatic lymph nodes in thyroid cancer BackgroundMetastatic lymph nodes in thyroid cancerResidual metastatic lymph nodes are the most common site of disease persistence or recurrence in thyroid cancer.Completeness of surgical resection is an important determinant of outcome in thyroid cancer.
3Metastatic lymph nodes in thyroid cancer BackgroundMetastatic lymph nodes in thyroid cancerPrevalence of cervical metastatic lymph nodes (MLN) is known to be relatively high (20~50%) , even in small intrathyroidal tumor.Incidence of lymph node resection and prevalence of MLN are not that high in certain surgery units.
4Metastatic lymph nodes in thyroid cancer BackgroundMetastatic lymph nodes in thyroid cancerLate local recurrence of thyroid cancer is reported to be relatively high (exceeds 25%) and it might be related to the hidden residual cancers in the cervical lymph nodes.
5BackgroundI-131 ablation in DTCI-131 ablation is known to decrease risk of recurrence and disease specific mortalityby the destruction of the suspected, but unproven metastatic disease.A number of studies showed a significant reduction in the rates of disease recurrence and cause-specific mortality by the I-131 ablation
6BackgroundPost I-131 ablation WBSPost ablation I-131 Whole body scan (WBS) is one of the most powerful imaging tools to detecting residual thyroid cancersPlanar WBS visualizes both residual normal thyroid tissues and persistent DTC;There is a difficulty to differentiate the metastatic lesion of a focal cervical radioiodine uptake in unusual cases.
7Post I-131 ablation SPECT/CT BackgroundPost I-131 ablation SPECT/CTSPECT/CT provides the synergistic combination of functional and anatomic information and has many advantages over the planar imaging in many clinical settings.I-131 SPECT/CT is able to allows more precise differentiation between malignant and benign radioiodine activities.
8ObjectivesAims of this studyTo evaluate prevalence of clinical metastatic cervical lymph nodes based on postablation I-131 SPECT/CT in thyroidectomized DTC patients with suspicious pathologic tracer uptake at neck area on the planar imaging.To elucidate fate of iodine avid cervical metastatic lesions by the I-131 ablation in DTC patients.
9SubjectsSubjects194 DTC patients who underwent postablation I-131 SPECT/CT owing to suspicious pathologic uptake at neck on planar WBS were enrolled.F/M=138:56Age; 48.6±12.2 yr
10MethodsMethodsThe patients were divided into remnant and metastasis groups based on postablation I-131 SPECT/CT finding.Clinicopathological characteristics were compared between the two groups.Fate of the residual MLN were assessed at 8 months after the ablation with TSH stimulated Tg, ultrasonography, chest X-ray, I-123 WBS, and etc.
12Prevalence of cervical lymph node metastases ResultsPrevalence of cervical lymph node metastasesPrevalence of cervical lymph node metastases based on postablation SPECT/CT findings in patients with suspicious pathologic uptake at neck on postablation planar WBS are following:Metastasis group : 73 patients (37.6%)Remnant group : 121 patients (62.4%)
13Patients characteristics (I) ResultsPatients characteristics (I)Metastasis group(n=73)Remnant group(n=121)P valueAge48.6±12.348.6±12.20.9664Sex (F:M)50:2388:330.6405Histologic type(papillary:follicular)73:0118:30.4501All 3 patients of follicular type were included in the remnant group.
15TSH stimulated Tg at I-131 ablation Metastasis group vs. Remnant group ResultsTSH stimulated Tg at I-131 ablation Metastasis group vs. Remnant groupng/mLP=0.033
16Clinical outcomes at 8 months after the ablation ResultsClinical outcomes at 8 months after the ablationMetastasis group (22)A patient ; persistent lymph node metastasis21 patients : no evidence of persistent or recurrent diseaseRemnant group (26)All 26 patients : no evidence of persistent or recurrent disease
17ResultsTSH stimulated Tg at 8 mo W/U disease free in metastasis group vs. remnant groupng/mLP=0.1905Disease freein metastasis groupDisease freein remnant group
19Case 1 CASE Recur work up at 8 month after the ablation TSH: 80.9uIU/mL, Tg: 284.3ng/mL, anti-Tg: U/mLFDG PETUltrasoundSurgical removal is planned for the metastastic lesions
20CASECase 2M/56, papillary type, III, T3NxMx, TSH: 77.76uIU/mL, Tg: 6.10ng/mL, anti-Tg: U/mLPost I-131 ablation WBS and SPECT/CTanteriorposteriorSPECT/CTremnant at thyroid bedDiagnosed as lymph node metastases.lymph node metastasis
21Case 2 CASE Recur work up at 8 month after the ablation TSH: 80.9uIU/mL, Tg: 0.92ng/mL, anti-Tg: 95.37U/mLNeck ultrasonography ; negativeI-123WBSRegular follow up was recommended.
22Summaries (I)Prevalence (37.6%) of cervical lymph node metastases based on postablation SPECT/CT findings was quite high in patients with suspicious pathologic uptake at neck on postablation planar WBS.Patients with metastatic cervical lymph modes had higher TSH stimulated Tg compared to patients without metastasis.
23Summaries (II)Only 1 of 22 patients with cervical lymph nodes metastases found on postablation SPECT/CT had persistent the metastases at 8 months after the ablation.Although statistically not significant, TSH stimulated Tg was higher in disease free patients of metastasis group than that of remnant group at 8 month after the ablation.
24ConclusionsPostablation SPECT/CT visualized residual metastatic lymph nodes (MLN) after surgery and prevalence of cervical MLN is high in patients showing suspicious pathologic uptake at neck on the postablation WBS.More than 95% of patients with residual cervical MLN receiving radioiodine ablation were in remission status at the 8 month after the ablation.