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Fate of Residual Cervical Metastatic Lymph nodes Found on I-131 Post-ablation SPECT/CT in Patients with Differentiated Thyroid Cancer 20121023- AOTA Hong.

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Presentation on theme: "Fate of Residual Cervical Metastatic Lymph nodes Found on I-131 Post-ablation SPECT/CT in Patients with Differentiated Thyroid Cancer 20121023- AOTA Hong."— Presentation transcript:

1 Fate of Residual Cervical Metastatic Lymph nodes Found on I-131 Post-ablation SPECT/CT in Patients with Differentiated Thyroid Cancer 20121023- AOTA Hong CM, Ahn BC, Jeong SY, Lee SW, Lee J Department of Nuclear Medicine Kyungpook National University School of Medicine & Hospital Discovery Kartika Plaza Hotel, Bali, Indonesia

2 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine Metastatic lymph nodes in thyroid cancer Residual 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. Background

3 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine Metastatic lymph nodes in thyroid cancer Prevalence 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. Background

4 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine Metastatic lymph nodes in thyroid cancer Late 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. Background

5 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine I-131 ablation in DTC I-131 ablation is known to decrease risk of recurrence and disease specific mortality –by 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 Background

6 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine Post I-131 ablation WBS Post ablation I-131 Whole body scan (WBS) is one of the most powerful imaging tools to detecting residual thyroid cancers Planar 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. Background

7 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine Post I-131 ablation SPECT/CT SPECT/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. Background

8 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine Aims of this study To 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. Objectives

9 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine Subjects 194 DTC patients who underwent postablation I-131 SPECT/CT owing to suspicious pathologic uptake at neck on planar WBS were enrolled. –F/M=138:56 –Age; 48.6±12.2 yr Subjects

10 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine Methods The 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. Methods

11 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine Statistics Independent student-T test Chi-square test, Fisher’s exact test P<0.05 Methods

12 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine Prevalence of cervical lymph node metastases Prevalence 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%) Results

13 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine Patients characteristics (I) Metastasis group (n=73) Remnant group (n=121) P value Age48.6±12.348.6±12.20.9664 Sex (F:M)50:2388:330.6405 Histologic type (papillary:follicular) 73:0118:30.4501 Results All 3 patients of follicular type were included in the remnant group.

14 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine Patients characteristics (II) Metastasis group (n=73) Remnant group (n=121) P value T stage (1:2:3:4) 12:3:47:531:2:74:120.3595 N stage (0:1a:1b) 16:30:1917:63:260.2038 AJCC Stage (I:II:III:IV) 23:2:31:1544:0:56:90.2223 Results

15 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine TSH stimulated Tg at I-131 ablation Metastasis group vs. Remnant group Results P=0.033 ng/mL

16 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine Clinical outcomes at 8 months after the ablation Metastasis group (22) –A patient ; persistent lymph node metastasis –21 patients : no evidence of persistent or recurrent disease Remnant group (26) –All 26 patients : no evidence of persistent or recurrent disease Results

17 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine TSH stimulated Tg at 8 mo W/U disease free in metastasis group vs. remnant group Results P=0.1905 ng/mL Disease free in metastasis group Disease free in remnant group

18 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine CASE M/56, papillary type, T3N1aMx, TSH: 41.16uIU/mL, Tg: 397.9ng/mL, anti-Tg: 118.8U/mL Post I-131 ablation WBS and SPECT/CT Case 1 anterior Right lateralLeft lateral SPECT/CT Diagnosed as lymph node metastases.

19 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine Recur work up at 8 month after the ablation TSH: 80.9uIU/mL, Tg: 284.3ng/mL, anti-Tg: 116.23U/mL Surgical removal is planned for the metastastic lesions Case 1 CASE FDG PETUltrasound

20 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine M/56, papillary type, III, T3NxMx, TSH: 77.76uIU/mL, Tg: 6.10ng/mL, anti-Tg: 106.44U/mL Post I-131 ablation WBS and SPECT/CT Case 2 CASE anterior SPECT/CT posterior Diagnosed as lymph node metastases. lymph node metastasis remnant at thyroid bed

21 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine Recur work up at 8 month after the ablation TSH: 80.9uIU/mL, Tg: 0.92ng/mL, anti-Tg: 95.37U/mL Neck ultrasonography ; negative Case 2 Regular follow up was recommended. CASE I-123WBS

22 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine Summaries (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.

23 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine Summaries (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.

24 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine Conclusions Postablation 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.

25 Kyungpook National University/Hospital School of Medicine Department of Nuclear Medicine


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