| Journal: | Arquivos brasileiros de endocrinologia e metabologia |
| Database: | PERIÓDICA |
| System number: | 000289503 |
| ISSN: | 0004-2730 |
| Authors: | Rosario, Pedro Weslley S. do1 Borges, Michelle A. Ribeiro1 Alves, Maria Flavia Gatti1 Purisch, Saulo1 Padrao, Eduardo Lanza1 Rezende, Leonardo Lamego1 Barroso, Alvaro Luis1 |
| Institutions: | 1Santa Casa de Belo Horizonte, Medicina Nuclear, Belo Horizonte, Minas Gerais. Brasil |
| Year: | 2006 |
| Season: | Oct |
| Volumen: | 50 |
| Number: | 5 |
| Pages: | 909-913 |
| Country: | Brasil |
| Language: | Portugués |
| Document type: | Artículo |
| Approach: | Caso clínico, analítico |
| English abstract | This study evaluated the follow-up of high-risk patients with thyroid cancer after initial therapy. A total of 125 high-risk patients (tumor >4 cm and/or extrathyroid invasion and/or lymph node metastases, and age >45 years), with complete resection of the tumor, were selected. All patients underwent total thyroidectomy and ablation with 131I [3.7­5.5 GBq (100-150 mCi)]. Eighteen patients (14.8%) presenting metastases on post-dose whole-body scan (RxWBS) were excluded. The negative predictive value of stimulated Tg <1 ng/ml in combination with neck US during first assessment (6­12 mo. after ablative therapy) was 96.2% for the absence of recurrence up to 5 years. This value increased to 98.7% when adding WBS performed with 185 MBq (5 mCi) 131I (DxWBS). The positive predictive value (PPV) of stimulated Tg >1 ng/ml was 52% for the detection of the presence of metastases up to 5 years; however, considering only patients with initially negative DxWBS and US, the PPV was 19% (9% if Tg of 1­10 ng/ml vs. 40% if Tg >10 ng/ml). Tg levels decreased spontaneously in patients with stimulated Tg >1 ng/ml during first assessment, negative US and DxWBS, and no recurrence during follow-up, with Tg being undetectable in half these patients at the end of 5 years. Twenty patients presented uptake in the thyroid bed upon DxWBS during the first year after ablative therapy, with stimulated Tg and US being negative, and were not treated with 131I; these patients did not relapse and no uptake on DxWBS was observed in 60% after 5 years. Recurrence after 5 years was only 1.3% in patients without apparent disease (negative US and DxWBS) and stimulated Tg <1 ng/ml. An algorithm for the follow-up of high-risk patients after initial therapy is presented in this study |
| Portuguese abstract | Este estudo avaliou o seguimento de pacientes com câncer de tireóide de alto risco, após a terapia inicial. Foram selecionados 125 pacientes de alto risco (tumor >4 cm e/ou invasão extra-tireoidiana e/ou metástases linfonodais e idade >45 anos), com ressecção tumoral completa. Todos foram tratados com tireoidectomia total e ablação com 131I [3,7­5,5 GBq (100­150 mCi)] e foram excluídos 18 casos (14,8%) com metástases na PCI pós-dose (t-PCI). O valor preditivo negativo da Tg estimulada <1 ng/ml combinada ao US cervical na primeira avaliação (6­12 meses após a terapia ablativa) foi de 96,2% para ausência de recidivas em até 5 anos. Este valor aumentou para 98,7% quando acrescentamos a PCI com 185 MBq (5 mCi) 131I (d-PCI). O valor preditivo positivo (VPP) da Tg estimulada >1 ng/ml foi de 52% para presença de metástases detectadas até 5 anos depois, mas considerando apenas pacientes que apresentaram d-PCI e US negativos inicialmente, o VPP foi 19% (9% se Tg 1­10 ng/ml vs. 40% se Tg >10 ng/ml). Tg reduziu espontaneamente nos pacientes com Tg estimulada >1 ng/ml na primeira avaliação, US e d-PCI negativos e sem recidiva no seguimento, sendo indetectável em metade destes ao final de 5 anos. No primeiro ano após a terapia ablativa, 20 pacientes tiveram captação em leito tireoidiano na d-PCI com Tg estimulada e US negativos e não foram tratados com 131I; estes evoluíram sem recidiva e 60% apresentavam uma d-PCI sem nenhuma captação após 5 anos. Em pacientes sem doença aparente (no US e d-PCI |
| Disciplines: | Medicina |
| Keyword: | Endocrinología, Oncología, Terapéutica y rehabilitación, Seguimiento, Alto riesgo, Cáncer, Tiroides |
| Keyword: | Medicine, Endocrinology, Oncology, Therapeutics and rehabilitation, Follow up, High risk, Cancer, Thyroid gland |
| Full text: | Texto completo (Ver HTML) |
