Objective: Developing of algorithm for the post-surgical management of patients with iodine-negative metastasesof differentiated thyroid cancer (DTC).
Materials and methods: The DTC patients with iodine-negative metastases (n = 115) were enrolled in the study.Of them the whole body scintigraphy (WBS) was performed with technetium-99m-hexakis-2-methoxyisobutylisonitrile(99mTc-MIBI) (n = 30), WBS with technetium-99m dimercaptosuccinic acid (99mTc-DMSA) (n = 30), 18FDG PET (n = 30), andcomputer tomography (CT-scan) (n = 25). Complex 99mTc-pertechnetate scans including the dynamic and static scintigraphy was performed supplementary to 99mTc-MIBI WBS in 10 patients to obtain the angiographic curves from DTCmetastatic foci. The non-radioiodine radiopharmaceutical technologies, namely the labeled 99mTc-MIBI, 99mTc-DMSA, 99mTc-pertechnetate, and 18FDG were applied to detect the iodine-negative DTC metastases. Radioisotopic examinationswere performed at the dual-head gamma camera (Mediso Medical Imaging Systems Ltd., Hungary) and single photonemission computed tomography (SPECT) scanner «E.CAM» (Siemens, Germany). PET/CT scans were performed on the«Biograph 64 TruePoint» imaging platform (Siemens, Germany) in accordance with the European Association of NuclearMedicine (EANM) recommendations for the Siemens imaging devices with 3D-mode data acquisition.
Results: The conducted research suggested that it is feasible to use the non-radioiodine (99mTc-MIBI and 99mTc-DMSA)radiopharmaceutical technologies to detect the iodine-negative DTC metastases. 18FDG PET is a highly informativetechnology for the detection of iodine-negative DTC metastases in case of lung involvement in the process. Compareof the non-radioiodine radiopharmaceuticals, CT scan and 18FDG-PET/CT indicated the highest sensitivity of 18FDGPET/CT (p < 0.05). WBS with 99mTc-MIBI and 99mTc-DMSA featured the highest specificity (100 %, p < 0.05). X-ray CTis marked by the significantly lower either sensitivity, specificity, and accuracy rate (p > 0.05). Developing andapplication of algorithm for the post-surgical management of patients with iodine-negative forms of DTC will allowfor the betimes detection of relapses and metastases with administration of adequate surgical, radiation, and targeted treatment.
Conclusions: Obtained results offer the opportunity to optimize the post-surgical management of patients withiodine-negative DTC forms using the options of radionuclide diagnostics with non-radioiodine radiopharmaceuticals. The latter are readily available providing the cost-cutting of diagnostic support in these patients. Place ofmorphological methods of diagnosis is determined and stage of monitoring of patients with the iodine-negativemetastases is established. Possibility of the 18FDG-PET tests for the early diagnosis of iodine-negative metastases inDTC for the first time have been studied and substantiated in Ukraine. A comprehensive radiation algorithm for thelong-term monitoring of this category of patients will allow the timely detection of recurrences and metastases ofDTC and appropriate surgery, radiation and targeted therapy administration. Data obtained as a result of the studyallowed to improve the overall and recurrence-free survival rates in the able-bodied DTC patients and reduce thecosts of follow-up of patients with iodine-negative forms of DTC.
Meta: rozrobyty algorytm pisliaoperatsiĭnogo vedennia khvorykh z ĭod-negatyvnymy metastazamy dyferentsiĭovanogo raku shchytopodibnoï zalozy (DRShchZ).Materialy i metody. Grupu doslidzhennia sklaly – 115 khvorykh z ĭod-negatyvnymy metastazamy DRShchZ, z iakykh 30patsiientam bulo provedeno stsyntygrafiiu vs'ogo tila (SVT) z michenym tekhnetsiiem-99 metoksy-izobutyl-izonitrylom (99mTc-MIBI), 30 – SVT z dymerkapto-burshtynovoiu kyslotoiu, michenoiu tekhnetsiiem-99 (99mTc-DMCA), 30 – PET z 18F-FDG, 25 patsiientam bula provedena komp’iuterna tomografiia (KT). Desiaty patsiientam z grupy, v iakiĭ provodyly SVT z 99mTc-MIBI, dodatkovo bulo provedeno kompleksne stsyntygrafichne doslidzhennia z 99mTc-pertekhnetatom,iake vkliuchalo dynamichnu ta statychnu stsyntygrafiï z metoiu oderzhannia angiografichnykh kryvykh z metastatychnykhvognyshch DRShchZ. Dlia diagnostyky ĭod-negatyvnykh metastaziv DRShchZ zastosovuvaly metodyky z vykorystanniamneĭodnykh radiofarmpreparativ (RFP), a same: micheni 99mTc-MIBI, 99mTc-DMCA, 99mTc-pertekhnetat i 18F-FDG. Radionuklidni doslidzhennia vykonuvaly na dvodetektorniĭ gamma-kameri firmy «Mediso» (Ugorshchyna) ta odnofotonnomu emisiĭnomu komp’iuternomu tomografi (OFEKT) «E. CAM 180» firmy «Siemens» (Nimechchyna). PET/KT provodyly na kombinovanomu tomografi «Biograph-64-TruePoint-Siemens» (Nimechchyna), zgidno z rekomendatsiieiu Ievropeĭs'koï Asotsiatsiï iadernoï medytsyny (EANM) dlia aparativ vyrobnytstva «Siemens» z 3D-rezhymom zbyranniainformatsiï.Rezul'taty. Provedeni doslidzhennia pidtverdyly mozhlyvist' vykorystannia metodyk z neĭodnymy RFP (99mTc-MIBI, 99mTc-DMCA) dlia vyiavlennia ĭod-negatyvnykh metastaziv DRShchZ. PET/KT z 18F-FDG ie vysokoinformatyvnoiu metodykoiu vyiavlennia ĭod-negatyvnykh metastaziv DRShchZ pry prolongatsiï protsesu v legeni. Porivnial'na otsinka neĭodnykhRFP, KT ta PET/KT z 18F-FDG vyiavyla, shcho naĭvyshchyĭ pokaznyk chutlyvosti kharakternyĭ dlia PET z 18F-FDG (r < 0,05).Spetsyfichnist' naĭbil'sh vysoka (100 %) pry SVT z 99mTc-MIBI i 99mTc-DMSA (r < 0,05). Rentgenivs'ka KT kharakteryzuiet'sia dostovirno nyzhchymy pokaznykamy iak chutlyvosti, tak i spetsyfichnosti ta tochnosti (r > 0,05). Stvorennia ivykorystannia algorytmu pisliaoperatsiĭnogo vedennia khvorykh z ĭod-negatyvnymy formamy DRShchZ dozvolyt' vchasno vyiavliaty retsydyvy ta metastazy i provodyty vidpovidne likuvannia, a same khirurgichne, promeneve ta targetne.Vysnovky. Oderzhani rezul'taty dozvolyly optymizuvaty pisliaoperatsiĭne vedennia patsiientiv z ĭod-negatyvnymy formamy DRShchZ na osnovi mozhlyvosteĭ radionuklidnoï diagnostyky z neĭodnymy RFP, iaki ie bil'sh dostupnymy, shcho stvoriuie mozhlyvosti zdeshevlennia diagnostychnogo suprovodu tsiieï kategoriï khvorykh. Vyznacheno mistse morfologichnykh metodiv diagnostyky ta vstanovlena etapnist' monitoryngu patsiientiv z ĭod-negatyvnymy metastazamy. Vpershe v Ukraïni vyvcheno ta obґruntovano mozhlyvosti PET-doslidzhen' z 18F-FDG dlia rann'oï diagnostykyĭod-negatyvnykh metastaziv pry DRShchZ. Stvorenyĭ kompleksnyĭ promenevyĭ algorytm tryvalogo monitoryngutsiieï kategoriï khvorykh dozvolyt' vchasno vyiavliaty retsydyvy ta metastazy DRShchZ i provodyty vidpovidnu terapiiu,a same khirurgichnu, promenevu ta targetnu. Oderzhani vnaslidok vykonannia doslidzhennia dani dozvolyly pokrashchyty pokaznyky zagal'noï ta bezretsydyvnoï vyzhyvanosti u pratsezdatnoï chastyny khvorykh na DRShchZ, zdeshevytysposterezhennia za patsiientamy z ĭod-negatyvnymy formamy DRShchZ.
Keywords: 18FDG-PET/CT; differentiated thyroid cancer; non-radioiodine radiopharmaceuticals; radioiodine-negative metastases.
O. I. Solodyannikova, Y. V. Kmetyuk, V. V. Danilenko, G. G. Sukach.