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

Xiaotong JIANG; Jinchuan LIU; Yingqiang ZHANG; Tong WANG; Ning GUO; Yuqing SUN; Cong SHI; Bing YAN; Yansong LIN

doi:10.19401/j.cnki.1007-3639.2025.01.009

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

Specialist' Article | 更新时间：2025-12-31

- The role of diagnostic whole body scan in decision-making of ¹³¹I treatment for differentiated thyroid cancer
- China Oncology Vol. 35, Issue 1, Pages: 77-84(2025)
- 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：
- 基金信息：
  
  National high level Hospital Clinical Research Funding(2022-PUMCH-B-072)
- DOI：10.19401/j.cnki.1007-3639.2025.01.009
  CLC： R736.1
- Received：28 December 2024，
  
  Revised：2025-01-18，
  
  Published：30 January 2025
- 稿件说明：
移动端阅览
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：

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%

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%

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

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AI问答

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

DOI：10.19401/j.cnki.1007-3639.2025.01.009

摘要

Abstract

关键词

Keywords

references

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