诊断性131I全身显像在分化型甲状腺癌131I治疗决策中的作用

doi:10.19401/j.cnki.1007-3639.2025.01.009

摘要/Abstract

摘要：

背景与目的： ¹³¹I治疗作为分化型甲状腺癌（differentiated thyroid cancer，DTC）的一线治疗方法之一，是大部分中高危DTC患者甲状腺全切或近全切除术后重要的治疗手段。而术后¹³¹I治疗前风险分层及实时动态评估是作出¹³¹I治疗决策的重要步骤，可实现个体化治疗。本研究拟探讨诊断性¹³¹I全身显像（diagnostic whole body scan，DxWBS）在DTC患者 ¹³¹I治疗前评估及治疗决策中的作用。方法： 回顾并分析具备术后¹³¹I治疗前评估资料的DTC患者，依据患者术后¹³¹I治疗前刺激性甲状腺球蛋白（stimulated thyroglobulin，sTg）水平分为低（sTg<1 ng/mL）、中（1 ng/mL≤sTg<10 ng/mL）、高（sTg≥10 ng/mL）3组，比较DxWBS与¹³¹I治疗后显像（post treatment whole body scan，RxWBS）在总体及不同Tg水平分组中的一致率，并评价DxWBS是否对¹³¹I治疗产生“顿抑效应”。通过与RxWBS对比，评价DxWBS在不同sTg水平DTC患者¹³¹I治疗前精准评估及治疗决策（清甲、辅助、清灶）中的作用。本研究已经获得中国医学科学院北京协和医学院北京协和医院伦理委员会批准（伦理编号：JS-2151）。结果： 研究共纳入91例患者，低、中、高sTg患者分别占15.4%（14/91）、34.1%（31/91）、50.5%（46/91）。比较各sTg组同一患者DxWBS与RxWBS结果，均未发现DxWBS对¹³¹I治疗产生“顿抑效应”。DxWBS和RxWBS总体一致率为89.0%（81/91），低、中、高sTg 3组中分别为100.0%（14/14）、90.3%（28/31）、84.8%（39/46）。结合sTg水平，DxWBS可以准确预判断清甲，RxWBS符合率为100%（20/20）；在71例因sTg、高复发风险分层或DxWBS提示可疑摄碘性转移病灶等预判断辅助治疗和（或）清灶治疗的患者中，87.5%（63/71）DxWBS显示残甲，经RxWBS及单光子发射计算机断层显像（single photon emission computed tomography，SPECT）/CT验证仅为残甲者占87.3%（62/71），探测到功能性颈部淋巴结转移和（或）肺转移者为12.7%（9/71）。在中、高sTg组（中位sTg为12.55 ng/mL）中，DxWBS与RxWBS对功能性颈部淋巴结转移的总体检出率均为5.5%（5/91）。对于功能性肺转移灶的检测，DxWBS的总体检出率略低于RxWBS（3.3% vs 5.5%）。提示DxWBS可用于精准预判¹³¹I治疗尤其是清甲及辅助治疗的目的。结论： DxWBS未产生明确“顿抑效应”，将DxWBS作为诊疗一体化手段整合进DTC实时¹³¹I治疗决策评估体系，有助于弥补基于病理学检查、临床资料、sTg等生化指标静态评估的不足，明确¹³¹I治疗目的、助力¹³¹I精准诊疗。

关键词: 分化型甲状腺癌, 诊断性¹³¹I全身显像, 甲状腺球蛋白

Abstract:

Background and purpose: As one of the first-line treatment methods for differentiated thyroid cancer (DTC), ¹³¹I treatment is an important therapeutic approach for most patients with medium-high recurrence risk DTC after total or near-total thyroidectomy. Risk stratification and real-time dynamic assessment before ¹³¹I treatment after surgery are important steps in deciding on ¹³¹I treatment, enabling individualized treatment. This retrospective study aimed to explore the role of diagnostic whole body scan (DxWBS) in the decision-making of treatment for DTC after surgery and before ¹³¹I therapy. Methods: DTC patients who underwent pre-ablation evaluation were included. Patients were divided into low, medium and high sTg groups based on their pre-¹³¹I treatment stimulated thyroglobulin (sTg) levels (<1 ng/mL, 1 ng/mL≤sTg<10 ng/mL, sTg≥10 ng/mL). The concordance rates of DxWBS and post treatment whole body scan (RxWBS) in each patient of the whole cohort were compared. The lesion detection rate between DxWBS and RxWBS in different sTg level groups was also explored. The “thyroid stunning effect” by DxWBS was evaluated by RxWBS. Through these analyses, the role of DxWBS in ¹³¹I treatment decision-making and its predicting treatment objectives were assessed. This study was approved by the Ethics Committee of Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences (ethics number: JS-2151). Results: A total of 91 patients were included. The low, medium and high sTg groups accounted for 15.4% (14/91), 34.1% (31/91) and 50.5% (46/91) of the patients, respectively. Comparison of DxWBS and RxWBS results in the same patients in each sTg group showed no evidence of a stunning effect on ¹³¹I treatment. The overall concordance rate between DxWBS and RxWBS was 89.0% (81/91); In different sTg level groups was 100.0% (14/14), 90.3% (28/31), 84.8% (39/46) respectively. Taking sTg levels into consideration, DxWBS accurately predicted the need for total thyroidectomy, with a 100% (20/20) agreement with RxWBS. Among the 71 patients who received adjuvant therapy and/or remnant ablation due to suspected elevated Tg or high recurrence risk stratification or the iodine-avid metastatic lesions identified by DxWBS, 87.5% (63/71) showed only residual thyroid tissue by DxWBS; Through the purpose verification by RxWBS and single photon emission computed tomography (SPECT)/CT, only 12.7% (9/71) of cases were verified as adjuvant or tumoricidal treatment due to iodine-avid cervical lymph node and/or lung metastasis identified by RxWBS, 87.3% (62/71) were residual thyroid ablation. In the medium and high sTg group, the overall detection rate of functional cervical lymph node metastasis by DxWBS and RxWBS was 5.5% (5/91). For the detection of functional lung metastases, the overall detection rate of DxWBS was slightly lower than that of RxWBS (3.3% vs 5.5%). This indicates that DxWBS can be used to accurately pre-judge the purposes of ¹³¹I treatment, particularly for thyroid ablation and adjuvant therapy. Conclusion: DxWBS did not induce “thyroid stunning” effect. Integrating DxWBS as a theranostic tool into the real-time decision-making and evaluation system of ¹³¹I treatment, as well as with sTg and other biochemical indicators, may help to bridge the limitations of static evaluations based on pathology and clinical data, and provides a clear understanding and more precise objectives of ¹³¹I treatment.

Key words: Differentiated thyroid cancer, Diagnostic whole body scan, Thyroglobulin

中图分类号:

R736.1

姜晓彤, 刘锦川, 张迎强, 王瞳, 郭宁, 孙郁青, 石聪, 颜兵, 林岩松. 诊断性¹³¹I全身显像在分化型甲状腺癌¹³¹I治疗决策中的作用[J]. 中国癌症杂志, 2025, 35(1): 77-84.

JIANG Xiaotong, LIU Jinchuan, ZHANG Yingqiang, WANG Tong, GUO Ning, SUN Yuqing, SHI Cong, YAN Bing, LIN Yansong. The role of diagnostic whole body scan in decision-making of ¹³¹I treatment for differentiated thyroid cancer[J]. China Oncology, 2025, 35(1): 77-84.

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参考文献 18

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Characteristic	Low sTg groups	Medium sTg groups	High sTg groups	χ²/H	P value
Gender				1.12	0.57
Male	4 (28.6)	14 (45.2)	19 (41.3)
Female	10 (71.4)	17 (54.8)	27 (58.7)
Age/year median (P25, P75)	46.00 (32.25, 55.25)	38.00 (31.00, 47.00)	34.00 (28.75, 40.75)	4.93	0.08
T staging				0.46	0.80
T1	8 (57.14)	18 (58.06)	27 (58.70)
T2	0 (0.00)	2 (6.45)	7 (15.22)
T3	3 (21.43)	4 (12.90)	7 (15.22)
T4	3 (21.43)	7 (22.58)	5 (10.87)
Tx	8 (57.14)	18 (58.06)	27 (58.70)
N staging				0.46	0.80
N0	1 (7.14)	4 (12.90)	1 (2.17)
N1	13 (92.86)	27 (87.10)	45 (97.83)
M staging				2.03	0.36
M₀	14 (100.00)	30 (96.77)	42 (91.30)
M₁	0 (0.00)	1 (3.23)	4 (8.70)
AJCC staging				1.13	0.57
Ⅰ	12 (85.71)	29 (93.55)	40 (86.96)
Ⅱ	0 (0.00)	2 (6.45)	5 (10.87)
Ⅲ	2 (14.29)	0 (0.00)	0 (0.00)
Ⅳ	0 (0.00)	0 (0.00)	1 (2.17)
Recurrence risks				0.00	1.00
Low	2 (14.29)	2 (6.45)	2 (4.35)
Medium	7 (50.00)	20 (64.52)	31 (67.39)
High	5 (35.71)	9 (29.03)	13 (28.26)

Case	Gender	Age/year	sTg/(ng·mL^-1)	DxWBS	Decision-making
1	Female	32	2.72	residual thyroid tissue, functional cervical lymph node metastasis	remnant ablation
2	Female	32	4.72	residual thyroid tissue, functional cervical lymph node metastasis	remnant ablation
3	Male	39	9.72	residual thyroid tissue, functional cervical lymph node metastasis	remnant ablation
4	Female	47	9.58	residual thyroid tissue, functional cervical lymph node metastasis	remnant ablation
5	Male	48	26.70	residual thyroid tissue, cervical lymph node and lung metastasis	remnant ablation
6	Male	37	39.00	residual thyroid tissue, lung metastasis	remnant ablation
7	Female	33	76.60	residual thyroid tissue, functional cervical lymph node metastasis	remnant ablation
8	Male	34	163.00	residual thyroid tissue, lung metastasis	remnant ablation

Characteristic	¹³¹I treatment dose/mCi	Case	RxWBS
Characteristic	¹³¹I treatment dose/mCi	Case	residual thyroid tissue	functional cervical lymph node metastasis	lung metastasis	cervical lymph node and lung metastasis
sTg<1 ng/mL 15.4% (14/91)	30	1	1	0	0	0
	80	1	1	0	0	0
	100	3	3	0	0	0
	125	7	7	0	0	0
	150	2	2	0	0	0
1 ng/mL≤sTg<10 ng/mL 34.1% (31/91)	30	3	3	0	0	0
	60	1	1	0	0	0
	100	7	7	0	0	0
	125	15	14	1	0	0
	150	5	2	2	0	1
sTg≥10 ng/mL 50.5% (46/91)	100	4	4	0	0	0
	125	17	17	0	0	0
	150	25	20	1	4	0

诊断性¹³¹I全身显像在分化型甲状腺癌¹³¹I治疗决策中的作用

The role of diagnostic whole body scan in decision-making of ¹³¹I treatment for differentiated thyroid cancer

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