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Hong CM, Ahn BC, Jeong SY, Lee SW, Lee J

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Presentation on theme: "Hong CM, Ahn BC, Jeong SY, Lee SW, Lee J"— Presentation transcript:

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

2 Metastatic lymph nodes in thyroid cancer
Background 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.

3 Metastatic lymph nodes in thyroid cancer
Background 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.

4 Metastatic lymph nodes in thyroid cancer
Background 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.

5 Background 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

6 Background 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.

7 Post I-131 ablation SPECT/CT
Background 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.

8 Objectives 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.

9 Subjects 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

10 Methods 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.

11 Statistics Independent student-T test
Methods Statistics Independent student-T test Chi-square test, Fisher’s exact test P<0.05

12 Prevalence of cervical lymph node metastases
Results 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%)

13 Patients characteristics (I)
Results Patients characteristics (I) Metastasis group (n=73) Remnant group (n=121) P value Age 48.6±12.3 48.6±12.2 0.9664 Sex (F:M) 50:23 88:33 0.6405 Histologic type (papillary:follicular) 73:0 118:3 0.4501 All 3 patients of follicular type were included in the remnant group.

14 Patients characteristics (II)
Results Patients characteristics (II) Metastasis group (n=73) Remnant group (n=121) P value T stage (1:2:3:4) 12:3:47:5 31:2:74:12 0.3595 N stage (0:1a:1b) 16:30:19 17:63:26 0.2038 AJCC Stage (I:II:III:IV) 23:2:31:15 44:0:56:9 0.2223

15 TSH stimulated Tg at I-131 ablation Metastasis group vs. Remnant group
Results TSH stimulated Tg at I-131 ablation Metastasis group vs. Remnant group ng/mL P=0.033

16 Clinical outcomes at 8 months after the ablation
Results 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

17 Results TSH stimulated Tg at 8 mo W/U disease free in metastasis group vs. remnant group ng/mL P=0.1905 Disease free in metastasis group Disease free in remnant group

18 CASE Case 1 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 Right lateral Left lateral SPECT/CT anterior Diagnosed as lymph node metastases.

19 Case 1 CASE Recur work up at 8 month after the ablation
TSH: 80.9uIU/mL, Tg: 284.3ng/mL, anti-Tg: U/mL FDG PET Ultrasound Surgical removal is planned for the metastastic lesions

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

21 Case 2 CASE 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 I-123WBS Regular follow up was recommended.

22 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 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 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.

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