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Negative whole-body scintigraphy linked to low recurrence in pediatric thyroid cancer
Negative whole-body scintigraphy results are highly predictive of lower recurrence risk in pediatric patients with well-differentiated thyroid carcinoma.
In the retrospective study, researchers evaluated the medical records of 112 patients younger than 22 years who were treated at the Washington University School of Medicine for well-differentiated thyroid carcinoma between 1969 and 2009.
The researchers assessed the effect of patient and tumor characteristics on PFS, along with the prognostic value of iodine-131 whole-body scintigraphy as a follow-up regimen.
The researchers found that the rates of PFS were 71% at 10 years, 62% at 20 years and 55% at 30 years. Although younger and male patients were more likely to present with more advanced disease, there was no relationship between PFS and age at diagnosis. Moreover, PFS was not affected by the presence of vascular invasion, capsular extension, positive margins or soft-tissue invasion.
Patients who underwent immediate postsurgical iodine-131 therapy had a mean time to recurrence of 3.8 years vs. 14.1 years in patients who either did not undergo iodine-131 therapy or underwent treatment in a salvage setting (P<.0001). There was a strongly predictive association between negative iodine-131 whole-body scintigraphy and decreased risk of relapse, particularly in patients with three negative scans in a row.
“Pediatric patients are more likely to present with advanced disease and for this reason, the majority of patients treated at our institution receive postoperative radioactive iodine,” the researchers wrote. “Long-term surveillance is required in this population because of the risk of late recurrences. Whole-body [iodine-131] scintigraphy is useful for risk stratification; after three consecutive negative scans the risk of recurrence is low.”