| Objective:The incidence rate of thyroid cancer(TC)is the highest in endocrine system.More than 90% of them are differentiated thyroid cancer(DTC).The main treatment methods of DTC patients include surgical treatment,radioactive 131I treatment,targeted treatment and so on.Thyroglobulin(Tg)is often used as a tumor marker to monitor tumor recurrence and metastasis in patients with DTC.This study will review and analyze the clinical data of 261 patients with differentiated thyroid cancer treated with radioactive 131I from October 2017 to March 2019 in the department of nuclear medicine of our hospital,and discuss the value of the preablative stimulated thyroglobulin(ps-Tg)and ps-Tg/thyroid-stimulating hormone(TSH)ratio levels under the condition of thyroid hormone withdrawal before the first postoperative radioactive 131I treatment in patients with DTC in prediction of metastasis.Methods:From October 2017 to March 2019,261 patients with DTC who were first treated with radioactive 131I in the department of nuclear medicine of our hospital were selected.Before the first radioactive 131I treatment,261 patients with DTC had undergone total thyroidectomy and neck lymph node dissection,including 103 males and 158 females,aged 19～74 years,with a median age of 44 years.The serum ps-Tg and ps-Tg/TSH ratio levels were measured 3～4 days before the first radioactive 131I treatment.The whole body imaging and single-photon emission computed tomography/computed tomography(SPECT/CT)imaging were performed 5～7 days after the first radioactive 131I treatment.According to the presence or absence of metastasis,261 patients were divided into metastasis group(M1)and non metastasis group(M0).The serum ps-Tg and ps-Tg/TSH ratio levels before treatment were compared between the two groups.The value of the serum ps-Tg and ps-Tg/TSH ratio levels in predicting metastasis was evaluated by receiver operating characteristic curve(ROC)and the best diagnostic critical point(DCP).Results:The median and P5-P95 of the serum ps-Tg and ps-Tg/TSH ratio levels in M0 group were 2.83 ng/ml(0.11～9.35 ng/ml)and 0.03 ng/μIU(0.00-0.10 ng/μIU),while Ml group were 45.36 ng/ml(2.85～549.32 ng/ml)、0.46 ng/μIU(0.02～9.17ng/μIU).The ps-Tg,ps-Tg/TSH between the above two groups was statistically significant(P<0.05).The areas under the ROC curves of the serum ps-Tg and ps-Tg/TSH ratio levels in the prediction of metastasis were 0.92、0.91,and the DCP was 11.15 ng/ml 和 0.12 ng/μIU,with a sensitivity of 80.2%,82.0%,a specificity of 99.0%,97.0%.The areas under the ROC curves of the serum ps-Tg and ps-Tg/TSH ratio levels in the prediction of cervical lymph node metastasis were 0.67 and 0.66,respectively.The best DCP was 2.70 ng/ml and 0.03ng/μIU,the sensitivity was 98.00%,89.80%,the specificity was 87.80%,76.40%,respectively.The areas under the ROC curves of the serum ps-Tg and ps-Tg/TSH ratio levels in the prediction of distant metastasis was 0.94 and 0.94 respectively.The best DCP was 15.38ng/ml and 0.16 ng/μIU,the sensitivity was 90.90%and 90.90%,the specificity was 88.30%and 87.40%.Conclusions:In this retrospective study,the serum ps-Tg and ps-Tg/TSH ratio levels of 261 patients with DTC before the first radioactive 131I treatment were significantly higher in M1 group than in M0 group,and the distant metastasis in M1 group was higher than that in cervical lymph node metastasis.The serum ps-Tg and ps-Tg/TSH ratio levels before the first radioactive 131I treatment are valuable markers in predicting DTC metastasis.Before the first radioactive 131I treatment,the serum ps-Tg and ps-Tg/TSH ratio levels predicted that the best DCP for the patients with postoperative metastasis of DTC was 11.15 ng/ml and 0.12 ng/μIU respectively;the best DCP for the patients with cervical lymph node metastasis was 2.7 ng/ml and 0.03 ng/μIU respectively;the best DCP for the patients with distant metastasis was 15.38 ng/ml and 0.16 ng/μIU respectively. |
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