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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
- 中国癌症杂志 2025年35卷第1期 页码：77-84
- 作者机构：
1. 中国医学科学院北京协和医学院北京协和医院核医学科，疑难重症及罕见病国家重点实验室，核医学分子靶向诊疗北京市重点实验室，北京 100730
2. 赤峰市医院核医学科，内蒙古 赤峰 024000
3. 北京霍普医院核医学科，北京 102206
- 作者简介：
[ "姜晓彤（ORCID:0009-0001-2299-9017），硕士，主治医师。颜兵，北京霍普医院核医学科主任，主任医师，从事核医学工作超过30年，专注于甲状腺疾病核医学相关诊疗。中国非公医疗机构协会甲状腺专业委员会副主任委员，北京医学会核医学分会治疗工作委员会副组长，北京医师协会核医学医师分会委员，中国医疗保健国际交流促进会甲状腺疾病学分会常委，中国临床肿瘤协会甲状腺癌专业委员会委员，中国医师协会核医学医师分会第二届委员会委员，中华医学会核医学分会第十一届委员会治疗学组委员，四川省医师协会核医学医师分会第二届委员会副会长。" ]
颜兵（ORCID: 0009-0002-8697-2515），主任医师，北京霍普医院核医学科主任。
林岩松（ORCID:0000-0001-6095-4728），博士，主任医师、教授，中国医学科学院北京协和医学院北京协和医院核医学科副主任；
- 基金信息：中央高水平医院临床科研专项(2022-PUMCH-B-072)
DOI：10.19401/j.cnki.1007-3639.2025.01.009
中图分类号： R736.1收稿：2024-12-28，
修回：2025-01-18，
纸质出版：2025-01-30
- 稿件说明：
移动端阅览
姜晓彤, 刘锦川, 张迎强, 等. 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.
Xiaotong JIANG, Jinchuan LIU, Yingqiang ZHANG, et al. 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.
姜晓彤, 刘锦川, 张迎强, 等. 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. DOI： 10.19401/j.cnki.1007-3639.2025.01.009.
Xiaotong JIANG, Jinchuan LIU, Yingqiang ZHANG, et al. 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. DOI： 10.19401/j.cnki.1007-3639.2025.01.009.
摘要
背景与目的：
131
I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
131
I治疗前风险分层及实时动态评估是作出
131
I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
131
I全身显像（diagnostic whole body scan，DxWBS）在DTC患者
131
I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
131
I治疗前评估资料的DTC患者，依据患者术后
131
I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
131
I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
131
I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
131
I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
131
I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
131
I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
131
I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
131
I治疗目的、助力
131
I精准诊疗。
Abstract
Background and purpose:
As one of the first-line treatment methods for differentiated thyroid cancer (DTC)
131
I 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
131
I treatment after surgery are important steps in deciding on
131
I 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
131
I 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-
131
I 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
131
I 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
131
I 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
131
I 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
131
I 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
131
I treatment.
关键词
Keywords
references
丁勇 , 马庆杰 , 王任飞 , 等 . 分化型甲状腺癌术后 131 I治疗前评估专家共识 [J ] . 中国癌症杂志 , 2019 , 29 ( 10 ): 832 - 840 .
DING Y , MA Q J , WANG R F , et al. Expert consensus on pre-treatment evaluation of 131 I after differentiated thyroid cancer surgery [J ] . China Oncol , 2019 , 29 ( 10 ): 832 - 840 .
MURATET J P , GIRAUD P , DAVER A , et al. Predicting the efficacy of first iodine-131 treatment in differentiated thyroid carcinoma [J ] . J Nucl Med , 1997 , 38 ( 9 ): 1362 - 1368 .
YAP B K , MURBY B . No adverse affect in clinical outcome using low preablation diagnostic 131 I activity in differentiated thyroid cancer: refuting thyroid-stunning effect [J ] . J Clin Endocrinol Metab , 2014 , 99 ( 7 ): 2433 - 2440 .
MICHAEL TUTTLE R , AHUJA S , AVRAM A M , et al. Controversies, consensus, and collaboration in the use of 131 I therapy in differentiated thyroid cancer: a joint statement from the American Thyroid Association, the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the European Thyroid Association [J ] . Thyroid , 2019 , 29 ( 4 ): 461 - 470 .
中华医学会核医学分会 . 131 I治疗分化型甲状腺癌指南(2021版) [J ] . 中华核医学与分子影像杂志 , 2021 , 41 ( 4 ): 218 - 241 .
Chinese Society of Nuclear Medicine . Guidelines for radioiodine therapy of differentiated thyroid cancer (2021 edition) [J ] . Chin J Nucl Med Mol Imag , 2021 , 41 ( 4 ): 218 - 241 .
HAUGEN B R , ALEXANDER E K , BIBLE K C , et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer [J ] . Thyroid , 2016, 26 ( 1 ): 1 - 133 .
ZHANG X Y , LIU L N , CHEN Y , et al. Prognostic value of post-ablation 131 I scintigraphy in children with thyroid cancer [J ] . Head Neck , 2020 , 42 ( 8 ): 1738 - 1745 .
RAWSON R W , RALL J E , PEACOCK W . Limitations and indications in the treatment of cancer of the thyroid with radioactive iodine [J ] . J Clin Endocrinol Metab , 1951 , 11 ( 10 ): 1128 - 1142 .
PARK H M . Stunned thyroid after high-dose 131 I imaging [J ] . Clin Nucl Med , 17 ( 6 ): 501 - 502 .
HU Y H , WANG P W , WANG S T , et al. Influence of 131 I diagnostic dose on subsequent ablation in patients with differentiated thyroid carcinoma: discrepancy between the presence of visually apparent stunning and the impairment of successful ablation [J ] . Nucl Med Commun , 2004 , 25 ( 8 ): 793 - 797 .
DAM H Q , KIM S M , LIN H C , et al. 131 I therapeutic efficacy is not influenced by stunning after diagnostic whole-body scanning [J ] . Radiology , 2004 , 232 ( 2 ): 527 - 533 .
SISSON J C , AVRAM A M , LAWSON S A , et al. The so-called stunning of thyroid tissue [J ] . J Nucl Med , 2006 , 47 ( 9 ): 1406 - 1412 .
DANILOVIC D L S , COURA-FILHO G B , RECCHIA G M , et al. Is there a role for diagnostic scans in the management of intermediate-risk thyroid cancer? [J ] . Endocr Relat Cancer , 2022 , 29 ( 8 ): 475 - 483 .
何紫燕 , 萨日 , 邱娴 , 等 . 诊断性 131 Ⅰ扫描在不明原因高甲状腺球蛋白血症PTC患者处置中的价值 [J ] . 肿瘤影像学 , 2022 , 31 ( 5 ): 498 - 503 .
HE Z Y , SA R , QIU X , et al. The value of diagnostic 131 Ⅰ scan in PTC patients with unexplained hyperthyroglobulinemia [J ] . Oncoradiology , 2022 , 31 ( 5 ): 498 - 503 .
MILLER J E , AL-ATTAR N C , BROWN O H , et al. Location and causation of residual lymph node metastasis after surgical treatment of regionally advanced differentiated thyroid cancer [J ] . Thyroid , 2018 , 28 ( 5 ): 593 - 600 . DOI: 10.1089/thy.2017.0434 http://doi.org/10.1089/thy.2017.0434
GUTIÉRREZ CARDO A L , RODRÍGUEZ RODRÍGUEZ J R , BORREGO DORADO I , et al. Patients treated for differentiated thyroid cancer with negative 131 I whole-body scans and elevated thyroglobulin levels: a possible course [J ] . Rev Esp Med Nucl , 2007 , 26 ( 3 ): 138 - 145 .
WEBB R C , HOWARD R S , STOJADINOVIC A , 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 ] . J Clin Endocrinol Metab , 2012 , 97 ( 8 ): 2754 - 2763 . DOI: 10.1210/jc.2012-1533 http://doi.org/10.1210/jc.2012-1533
ZHANG X , LIU J R , MU Z Z , et al. Response to surgery assessments for sparing radioiodine remnant ablation in intermediate-risk papillary thyroid cancer [J ] . J Clin Endocrinol Metab , 2023 , 108 ( 6 ): 1330 - 1337 .
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