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Vol. 40. Issue 1.
Pages 30-36 (January - February 2021)
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Vol. 40. Issue 1.
Pages 30-36 (January - February 2021)
Original Article
DOI: 10.1016/j.remnie.2020.03.005
Prognostic value of star-shaped intense uptake of 131I in thyroid cancer patients
Valores pronósticos de la captación en estrella de I-131 en pacientes con cáncer diferenciado de tiroides
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Liu Xiao1, Wen Jie Zhang1, Yue Qi Wang, Lin Li
Corresponding author
lilinhuaxi@sina.com

Corresponding author.
Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 Guoxue Alley, 610041 Chengdu, Sichuan Province, PR China
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Figures (2)
Tables (5)
Table 1. Comparison of the demographic and clinical features of patients with and without SA.
Table 2. Univariate logistic regression analysis of the odds ratios for star artifacts.
Table 3. Multivariate linear regression analysis of the risk factors of SA.
Table 4. sTg and ablation success rate.
Table 5. The follow up outcome about therapeutic response in SA+ and SA− patients according to dynamic risk stratification released in 2015 ATA guidelines in TgAb-negative patients.
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Abstract
Objective

After 131I treatment in patients with differentiated thyroid carcinoma (DTC), we sometimes find a star-shaped intense uptake of 131I on therapeutic whole body scans (Rx-WBS), called star artifacts. Therefore, we analyzed the relevant clinical factors and prognostic value of star artifacts in DTC patients.

Methods

809 DTC patients who received 131I treatment were retrospectively evaluated and divided into 2 groups of patients with and without star artifacts. We evaluated the therapeutic response which was divided into excellent response (ER), biochemical incomplete response (BIR), indeterminate response (IR), and structural incomplete response (SIR). Clinical factors for the presence of star artifacts were analyzed. We also compared the rate of ER, BIR, IR, SIR and recurrence rate between group 1 and group 2.

Results

The major clinical factors included stimulated thyroglobulin (sTg)>1.8ng/ml, 24h radioiodine uptake (RAIU)>2.2%, and positive 99mTcO4 thyroid imaging for the presence of star artifacts. In patients with sTg levels>10ng/ml, patients in group 1 had a higher rate of ablation success and ER than patients in group 2 (80.2% vs 65.6%, P=0.038, 31.6% vs 13.1%, P=0.008, respectively) and had a similar rate of BIR, IR, SIR. Recurrence rate was similar between group 1 and group 2 (5.2% vs 3.1%, P=0.13).

Conclusion

More remnant thyroid tissue is one of the factors associated with the presence of star artifacts on Rx-WBS. Patients with star artifacts exhibit a better therapeutic response (ER) when sTg levels are >10ng/ml. However, star artifacts have no effect on the recurrence rate.

Keywords:
Differentiated thyroid carcinoma
Radioactive iodine
Star artifacts
Ablation
Thyroglobulin
Resumen
Objetivo

Después del tratamiento con 131I en pacientes con carcinoma diferenciado de tiroides (DTC), a veces encontramos una captación intensa en forma de estrella de 131I en las exploraciones terapéuticas de todo el cuerpo (Rx-WBS), llamadas artefactos estelares. Por lo tanto, analizamos los factores clínicos relevantes y el valor pronóstico de los artefactos estelares en los pacientes con DTC.

Métodos

809 pacientes con DTC que recibieron el tratamiento 131I fueron evaluados retrospectivamente y divididos en 2 grupos de pacientes con y sin artefactos estelares. Evaluamos la respuesta terapéutica que se dividió en respuesta excelente (ER), respuesta bioquímica incompleta (BIR), respuesta indeterminada (IR) y respuesta estructural incompleta (SIR). Se analizaron los factores clínicos de la presencia de artefactos estelares. También comparamos la tasa de ER, BIR, IR, SIR y la tasa de recurrencia entre el grupo 1 y el grupo 2.

Los resultados

Los principales factores clínicos incluyeron tiroglobulina estimulada (sTg) >1.8ng/ml, captación de yodo radioactivo (RAIU) >2.2%, e imagen positiva de la tiroides 99mTcO4 para la presencia de artefactos estelares. En los pacientes con niveles de sTg >10ng/ml, los pacientes del grupo 1 tuvieron una mayor tasa de éxito en la ablación y en la sala de emergencias que los pacientes del grupo 2 (80,2% vs 65,6%, P=0,038, 31,6% vs 13,1%, P=0,008, respectivamente) y tuvieron una tasa similar de BIR, IR, SIR. La tasa de recurrencia fue similar entre el grupo 1 y el grupo 2 (5,2% vs 3,1%, P=0,13).

Conclusión

Un mayor tejido tiroideo remanente es uno de los factores asociados a la presencia de artefactos estelares en Rx-WBS. Los pacientes con artefactos estelares exhiben una mejor respuesta terapéutica (RE) cuando los niveles de sTg son >10ng/ml. Sin embargo, los artefactos estelares no tienen ningún efecto en la tasa de recurrencia.

Palabras clave:
Carcinoma tiroideo diferenciado
Yodo radiactivo
Artefactos estelares
Ablación
Tiroglobulina

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