Influence of Post therapy 131I SPECT/CT on risk stratification in Patients with Differentiated thyroid cancer — ASN Events
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Influence of Post therapy 131I SPECT/CT on risk stratification in Patients with Differentiated thyroid cancer (#105)

SATYAWATI DESWAL 1 , VIBHOR MAHENDRU 2 , DHANANJAY SINGH 1 , SHASHWAT VERMA 1
  1. DR RAM MANOHAR LOHIA INSTITUTE OF MEDICAL SCIENCES, LUCKNOW, UTTAR PRADESH, India
  2. SURGERY, ERA'S LUCKNOW MEDICAL COLLEGE, LUCKNOW, UTTAR PRADESH, INDIA

Background: Radioiodine (I-131) therapy after near total or  total throidectomy is the standard treatment in patients with differentiated thyroid cancer. SPECT/CT instruments allow contemporaneous SPECT and CT scanning for anatomic localization, which increases the certainty of information available from these post therapy images.

Objective: we prospectively assessed the impact of SPECT/ CT on initial risk classification and management of the patients with DTC in intermediate- and high-risk patients between April 2014 and March 2016.

Materials and Methods:  In 69 patients with thyroid cancer, whole-body scintigraphy (WBS), SPECT, and SPECT/CT were prospectively performed 2-10 days after administration of  1110- 6475 MBq (30-175 mCi) of  I-131. SPECT/CT of the head and neck/other site if required, was performed in all patients.

 

Results:  We compared post therapy I-131 imaging findings on planar and SPECT/CT scans, assessed the clinical utility of SPECT/CT in the initial risk classification of the patients with differentiated thyroid in intermediate- and high-risk patients. We analyzed the data of 69 patients with mean age of 40.85±13.89 years. Fifty seven of the 69 patients underwent postsurgical I-131 ablation of residual thyroid tissue and 12 of 69 patients, for suspected or proven metastatic disease. SPECT/CT helped to localize focal iodine uptake and characterize it as either normal or abnormal, thereby reducing the need for additional imaging studies. In postthyroidectomy patients, SPECT/CT findings affected the ATA risk classification, with implications for management by changing the interval for clinical follow-up and the need for additional imaging and laboratory tests. Our study found a 11% change in nodal status in the postsurgical group. Change in patient management was observed in 18%.

 

Conclusions : SPECT/CT significantly reduced the number of equivocal findings on post therapy planar 131I scans.  Post therapy radioiodine scan did affect the initial risk stratification in patients with differentiated thyroid cancer.