1. A Sensitive Tg Assay or rhTSH Stimulated Tg: What's the Best in the Long-Term Follow-Up of Patients with Differentiated Thyroid Carcinoma?
- Author
-
Thera P. Links, Bruce H. R. Wolffenbuttel, John T. M. Plukker, Pieter L. Jager, Wim J. Sluiter, Adrienne C. M. Persoon, Damage and Repair in Cancer Development and Cancer Treatment (DARE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), Life Course Epidemiology (LCE), Lifestyle Medicine (LM), and Center for Liver, Digestive and Metabolic Diseases (CLDM)
- Subjects
Adult ,Radiology and Medical Imaging ,Long term follow up ,medicine.medical_treatment ,Radiology and Medical Imaging/Ultrasonography ,Thyrotropin ,lcsh:Medicine ,Stimulation ,Sensitivity and Specificity ,Thyroglobulin ,Diabetes and Endocrinology/Thyroid ,Thyroid carcinoma ,Thyroid-stimulating hormone ,Humans ,Medicine ,Thyroid Neoplasms ,Evidence-Based Healthcare/Methods for Diagnostic and Therapeutic Studies ,lcsh:Science ,Oncology/Head and Neck Cancers ,Multidisciplinary ,medicine.diagnostic_test ,business.industry ,Carcinoma ,lcsh:R ,Thyroid ,Magnetic resonance imaging ,Middle Aged ,medicine.anatomical_structure ,Radiology and Medical Imaging/PET and SPECT Imaging ,Biological Assay ,lcsh:Q ,Neoplasm Recurrence, Local ,business ,Nuclear medicine ,Follow-Up Studies ,Research Article ,Hormone - Abstract
Sensitivity of thyroglobulin (Tg) measurement in the follow-up of differentiated thyroid carcinoma (DTC) can be optimized by using a sensitive Tg assay and rhTSH stimulation. We evaluated the diagnostic yield of a sensitive Tg assay and rhTSH stimulated Tg in the detection of recurrences in the follow-up of DTC. Additionally the value of imaging techniques for the localization of recurrences was evaluated. We included 121 disease free patients in long-term follow-up for DTC (median 10 years, range 1-34). Tg during thyroid hormone suppression therapy (Tg-on) and rhTSH stimulated Tg were measured with a sensitive Tg assay. Patients with rhTSH stimulated Tg >= 1.0 ng/ml underwent imaging with neck ultrasound, FDG-PET and post therapy (131)I WBS. Sensitive Tg measurement resulted in 3 patients with Tg-on >= 1.0 ng/ml, recurrence could be localized in 2 of them. RhTSH stimulation resulted in Tg >= 1.0 ng/ml in another 17 of 118 patients. Recurrence could be localized in only 1 additional patient (1 out of 118 patients). Recurrence was localized by neck ultrasound in 1 of 3, by FDG-PET in 2 of 3 and by post therapy (131)I WBS in 2 of 3 patients. In the detection of recurrences in DTC, rhTSH stimulation had very limited additional value in comparison to Tg-on measurement with a sensitive Tg assay. We consider this too low to justify rhTSH stimulation in all patients during long-term follow up. Neck ultrasound, FDG-PET and post therapy (131)I WBS showed complementary value in localization of disease, but were only positive in a small fracture of all procedures.
- Published
- 2007