A cutoff thyroglobulin value suggestive of distant metastases in differentiated thyroid cancer patients

A cutoff thyroglobulin value suggestive of distant metastases in differentiated thyroid cancer patients

Serum thyroglobulin is used as part of the early postoperative assessment of differentiated thyroid cancer (DTC) since there is a clear relationship between an increased risk of recurrence and persistent disease after initial treatment and high postoperative stimulated thyroglobulin (ps-Tg) values....

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Published in:Brazilian journal of medical and biological research Vol. 53; no. 11; p. e9781
Main Authors: Couto, J.S, Almeida, M.F.O, Trindade, V.C.G, Marone, M.M.S, Scalissi, N.M, Cury, A.N, Ferraz, C, Padovani, R.P
Format: Journal Article
Language:English
Published: Ribeirao Preto Associacao Brasileira de Divulgacao Cientifica (ABDC) 01-01-2020
Revista Brasileira de Pesquisas Medicas
Associação Brasileira de Divulgação Científica
Subjects:
BIOLOGY
Bone imaging
Cancer patients
Care and treatment
Cervix
Cutoff point
Distant metastasis
High risk
Iodine
Mediastinum
Medical research
MEDICINE, RESEARCH & EXPERIMENTAL
Metastases
Metastasis
Nuclear medicine
Prognosis
Recurrence (Disease)
Stimulated thyroglobulin
Thyroglobulin
Thyroid cancer
Thyroidectomy
Brazil
Taiwan
Distant metastasis
High risk
Cutoff point
Thyroid cancer
Stimulated thyroglobulin
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Summary:Serum thyroglobulin is used as part of the early postoperative assessment of differentiated thyroid cancer (DTC) since there is a clear relationship between an increased risk of recurrence and persistent disease after initial treatment and high postoperative stimulated thyroglobulin (ps-Tg) values. Thus, although ps-Tg above 10-30 ng/mL is considered an independent predictor of worse prognosis, the value that is associated with distant metastases is not defined. Thus, this was our objective. We selected 655 DTC patients from a nuclear medicine department database (Irmandade Santa Casa de Misericordia de Sao Paulo, Brazil). All patients had received total thyroidectomy and radioactive iodine (RAI) therapy and had ps-Tg values higher than 10 ng/mL with negative anti-thyroglobulin antibodies. Then, we selected patients who presented post-therapy whole-body scan with pulmonary and/or bone uptake but with no mediastinum or cervical uptake. Patients with negative findings on functional imaging or any doubt on lung/bone uptake were submitted to additional exams to exclude another non-thyroid tumor. Of the 655 patients, 14.3% had pulmonary and 4.4% bone metastases. There was a significant difference in ps-Tg levels between patients with and without metastases (P< 0.001). The cutoff value of ps-Tg was 117.5 ng/mL (sensitivity: 70.2%; specificity: 71.7%) for those with lung metastasis, and 150.5 ng/mL (sensitivity: 79.3%; specificity: 85%) for those with bone metastasis. The cutoff value for patients with eitherpulmonary or bone metastasis was 117.5 ng/mL (sensitivity: 70.2%; specificity: 83.7%). Our findings demonstrated that ps-Tg could predict distant metastasis in DTC patients. We identified a cutoff of 117.5 ng/mL with a high negative predictive value of 93.7%. Key words: Thyroid cancer; Stimulated thyroglobulin; Cutoff point; High risk; Distant metastasis
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ISSN:0100-879X
1414-431X
1414-431X
1678-4510
DOI:10.1590/1414-431X20209781