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Detection of distant metastasis at the time of ablation in children with differentiated thyroid cancer: the value of pre-ablation stimulated thyroglobulin

  • Lina Liu , Fang Huang , Bin Liu EMAIL logo and Rui Huang EMAIL logo
Published/Copyright: June 28, 2018

Abstract

Background

The present study was designed to determine the value of pre-ablation stimulated thyroglobulin (s-Tg) in predicting distant metastasis (DM) at the time of ablation in children with differentiated thyroid cancer.

Methods

From August 2009 to December 2016, consecutive children with differentiated thyroid cancer undergoing remnant ablation were retrospectively analyzed. Serum s-Tg was measured with the high-sensitive electrochemiluminescence immunoassay during hypothyroidism at ablation just before the ablative radioactive iodine (131I) administration. Post-ablation, whole body planar scintigraphy was obtained 5 days after administration of ablation activity of 131I. Single photon emission computed tomography/low-dose computed tomography (SPECT/CT) was added for children whose planar findings were inconclusive. Receiver-operating characteristics (ROC) curve analysis was employed to find a cut-off level of pre-ablation s-Tg as a predictor of DM at the time of ablation.

Results

Fifty-seven children were included for the analysis. Metastases were noticed on post-ablation scintigraphy in 20 (35%) children: five post-operative residual neck lymph node metastases, four post-operative residual neck lymph node and lung metastases, three mediastinal lymph node and lung metastases and eight lung metastases. A significant difference in pre-ablation s-Tg levels was found in children with DM compared with those without DM, 603.5 vs. 5.7 ng/mL, respectively. A pre-ablation s-Tg level of 156 ng/mL was established as the optimal cut-off point to predict DM.

Conclusions

This study demonstrated that pre-ablation s-Tg could potentially act as a predictor of DM at the time of ablation in children with differentiated thyroid cancer. We also propose a specific pre-ablation s-Tg cut-off value of 156 ng/mL as an optimal threshold for practical use.


Corresponding authors: Bin Liu, MD and Rui Huang, MD, Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37. Guoxue Alley, 610041 Chengdu, P.R. China, Phone (O): +86-28-85422696 (B. Liu)/+86-28-85422400 (R. Huang), Phone (M): +86-0-18280047057 (B. Liu)/+86-0-18980605781 (R. Huang)
aLina Liu and Fang Huang contributed equally to this work.
  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: This work was supported by the National Natural Science Fund of China (grant 81401445).

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Tracy ET, Roman SA. Current management of pediatric thyroid disease and differentiated thyroid cancer. Curr Opin Oncol 2016;28:37–42.10.1097/CCO.0000000000000250Search in Google Scholar PubMed

2. Olmsted C, Arunachalam R, Gao X, Pesce L, Lal G. Pediatric differentiated thyroid carcinoma: trends in practice and outcomes over 40 years at a single tertiary care institution. J Pediatr Endocrinol Metab 2017;30:1067–74.10.1515/jpem-2016-0327Search in Google Scholar PubMed

3. Pires BP, Alves PA, Jr., Bordallo MA, Bulzico DA, Lopes FP, et al. Prognostic factors for early and long-term remission in pediatric differentiated thyroid carcinoma: the role of sex, age, clinical presentation, and the newly proposed American thyroid association risk stratification system. Thyroid 2016;26:1480–7.10.1089/thy.2016.0302Search in Google Scholar PubMed

4. Bal CS, Garg A, Chopra S, Ballal S, Soundararajan R. Prognostic factors in pediatric differentiated thyroid cancer patients with pulmonary metastases. J Pediatr Endocrinol Metab 2015;28: 745–51.10.1515/jpem-2014-0247Search in Google Scholar PubMed

5. Parisi MT, Eslamy H, Mankoff D. Management of differentiated thyroid cancer in children: focus on the American Thyroid Association Pediatric Guidelines. Semin Nucl Med 2016;46: 147–64.10.1053/j.semnuclmed.2015.10.006Search in Google Scholar PubMed

6. Bachelot A, Cailleux AF, Klain M, Baudin E, Ricard M, et al. Relationship between tumor burden and serum thyroglobulin level in patients with papillary and follicular thyroid carcinoma. Thyroid 2002;12:707–11.10.1089/105072502760258686Search in Google Scholar PubMed

7. Webb RC, Howard RS, Stojadinovic A, Gaitonde DY, Wallace MK, et al. The utility of serum thyroglobulin measurement at the time of remnant ablation for predicting disease-free status in patients with differentiated thyroid cancer: a meta-analysis involving 3947 patients. J Clin Endocrinol Metab 2012;97:2754–63.10.1210/jc.2012-1533Search in Google Scholar PubMed

8. Makarewicz J, Adamczewski Z, Knapska-Kucharska M, Lewinski A. Evaluation of the diagnostic value of the first thyroglobulin determination in detecting metastases after differentiated thyroid carcinoma surgery. Exp Clin Endocrinol Diabetes 2006;114:485–9.10.1055/s-2006-951778Search in Google Scholar PubMed

9. Lin Y, Li T, Liang J, Li X, Qiu L, et al. Predictive value of preablation stimulated thyroglobulin and thyroglobulin/thyroid-stimulating hormone ratio in differentiated thyroid cancer. Clin Nucl Med 2011;36:1102–5.10.1097/RLU.0b013e3182291c65Search in Google Scholar PubMed

10. Zhao T, Liang J, Li T, Gao W, Lin Y. Serial stimulated thyroglobulin measurements are more specific for detecting distant metastatic differentiated thyroid cancer before radioiodine therapy. Chin J Cancer Res 2017;29:213–22.10.21147/j.issn.1000-9604.2017.03.07Search in Google Scholar PubMed PubMed Central

11. Klein Hesselink MS, Nies M, Bocca G, Brouwers AH, Burgerhof JG, et al. Pediatric differentiated thyroid carcinoma in the Netherlands: a nationwide follow-up study. J Clin Endocrinol Metab 2016;101:2031–9.10.1210/jc.2015-3290Search in Google Scholar PubMed

12. Liu B, Chen Y, Jiang L, He Y, Huang R, et al. Is postablation whole-body 131 I scintigraphy still necessary in intermediate-risk papillary thyroid cancer patients with pre-ablation stimulated thyroglobulin <1 ng/mL? Clin Endocrinol 2017;86:134–40.10.1111/cen.13158Search in Google Scholar PubMed

13. Rosario PW, Xavier AC, Calsolari MR. Value of postoperative thyroglobulin and ultrasonography for the indication of ablation and (1)(3)(1)I activity in patients with thyroid cancer and low risk of recurrence. Thyroid 2011;21:49–53.10.1089/thy.2010.0145Search in Google Scholar PubMed

14. Melo M, Costa G, Ribeiro C, Carrilho F, Martins MJ, et al. Stimulated thyroglobulin at recombinant human TSH-aided ablation predicts disease-free status one year later. J Clin Endocrinol Metab 2013;98:4364–72.10.1210/jc.2013-2267Search in Google Scholar PubMed

15. Vaisman A, Orlov S, Yip J, Hu C, Lim T, et al. Application of post-surgical stimulated thyroglobulin for radioiodine remnant ablation selection in low-risk papillary thyroid carcinoma. Head Neck 2010;32:689–98.10.1002/hed.21371Search in Google Scholar PubMed

16. Giovanella L, Suriano S, Ceriani L, Verburg FA. Undetectable thyroglobulin in patients with differentiated thyroid carcinoma and residual radioiodine uptake on a postablation whole-body scan. Clin Nucl Med 2011;36:109–12.10.1097/RLU.0b013e318203bb84Search in Google Scholar PubMed

17. Nascimento C, Borget I, Al Ghuzlan A, Deandreis D, Chami L, et al. Persistent disease and recurrence in differentiated thyroid cancer patients with undetectable postoperative stimulated thyroglobulin level. Endocr-Relat Cancer 2011;18:R29–40.10.1677/ERC-10-0292Search in Google Scholar PubMed

18. Orlov S, Salari F, Kashat L, Freeman JL, Vescan A, et al. Post-operative stimulated thyroglobulin and neck ultrasound as personalized criteria for risk stratification and radioactive iodine selection in low- and intermediate-risk papillary thyroid cancer. Endocrine 2015;50:130–7.10.1007/s12020-015-0575-0Search in Google Scholar PubMed

19. Agac Ay A, Kutun S, Cetin A. Are the characteristics of thyroid cancer different in young patients? J Pediatr Endocrinol Metab 2014;27:497–502.10.1515/jpem-2013-0192Search in Google Scholar PubMed

20. Livhits MJ, Pasternak JD, Xiong M, Li N, Gosnell JE, et al. Pre-ablation thyroglobulin and thyroglobulin to thyroid-stimulating hormone ratio may be associated with pulmonary metastases in children with differentiated thyroid cancer. Endocr Pract 2016;22:1259–66.10.4158/EP161360.ORSearch in Google Scholar PubMed

21. Zanella A, Scheffel RS, Pasa MW, Dora JM, Maia AL. Role of postoperative stimulated thyroglobulin as prognostic factor for differentiated thyroid cancer in children and adolescents. Thyroid 2017;27:787–92.10.1089/thy.2016.0559Search in Google Scholar PubMed

22. Mourao GF, Rosario PW, Calsolari MR. Low postoperative nonstimulated thyroglobulin as a criterion to spare radioiodine ablation. Endocr-Related Cancer 2016;23:47–52.10.1530/ERC-15-0458Search in Google Scholar PubMed

23. Giovanella L, Feldt-Rasmussen U, Verburg FA, Grebe SK, Plebani M, et al. Thyroglobulin measurement by highly sensitive assays: focus on laboratory challenges. Clin Chem Lab Med 2015;53:1301–14.10.1515/cclm-2014-0813Search in Google Scholar PubMed

Received: 2018-02-11
Accepted: 2018-05-14
Published Online: 2018-06-28
Published in Print: 2018-07-26

©2018 Walter de Gruyter GmbH, Berlin/Boston

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