The Incremental Value Of I-131 Spect/Ct Of The Neck In The Management Of Differentiated Thyroid Carcinoma

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Date
2017
Authors
Mohamad Najib, Fatin Hayyani
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Publisher
Universiti Sains Malaysia
Abstract
Aim: To assess the clinical value of single-photon emission computed tomography/computed tomography (SPECT/CT) of the neck in the management of differentiated thyroid carcinoma (DTC). Material and methods: I-131 planar whole body scan and SPECT/CT of the neck were performed in 78 patients with histologically confirmed diagnosis of differentiated thyroid carcinoma. The scan findings made by each I-131 planar whole body scan and SPECT/CT of the neck were analysed. Clinical staging based on TNM staging classification and risk stratification group were assessed and compared based on information given by each I-131 planar whole body scan and SPECT/CT of the neck. Subsequently, clinical management plan made by each planar and SPECT/CT of the neck were assessed and compared for significant impact on overall patient management. Results: Data from 78 patients with total of 91 radioiodine foci in the neck region was observed and analysed by both I-131 planar whole body scan and SPECT/CT of the neck. On lesion based analysis, I-131 planar whole body scan yield diagnostic information in 76 foci (83.5%) in which 49 foci were classified as thyroid remnant while the remaining 27 foci were classified as lymph node. SPECT/CT of the neck yield a better diagnostic information in 88 foci (96.7%). SPECT/CT of the neck has changed diagnosis given by I-131 planar whole body scan in 30 foci (33%, p<0.001). On patient based analysis, the findings of I-131 planar whole body scan were altered in 29 (37.2%, p<0.001) out of 78 patients in based on SPECT/CT findings. Clinical staging according to TNM classification was revised with additional information obtained by using SPECT/CT in 8 (10.2%) of 78 patients. The risk stratification group was revised with additional information obtained from SPECT/CT in 15 (19.2%) of 78 patients. SPECT/CT of the neck may significantly alter the personalised treatment planning for each patient with differentiated thyroid carcinoma (p<0.001). Conclusion: SPECT/CT of the neck has shown a significant diagnostic impact as compared to I-131 planar whole body scan alone. SPECT/CT also had a significant impact on the management of patients with differentiated thyroid carcinoma.
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Keywords
Differentiated thyroid carcinoma , iodine-131, planar scintigraphy
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