Efficacy and safety analysis of anlotinib in the treatment of distant metastatic radioactive iodine-refractory differentiated thyroid cancer / 中华核医学与分子影像杂志

Objective:To investigate the efficacy and safety of anlotinib in distant metastatic radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC).Methods:Retrospective analysis was performed on 17 patients with distant metastatic RAIR-DTC (6 males, 11 females, age: 57.0(45.5, 63.0) years) from Affiliated Hospital of Qingdao University between October 2018 and February 2023, including 13 patients receiving first-line treatment and 4 patients receiving second-line treatment with anlotinib. The changes of serum thyroglobulin (Tg) during the treatment of anlotinib, the changes of maximum diameter of the target lesion at the last follow-up compared with the diameter at baseline, the imaging efficacy, and treatment-related adverse events were analyzed. The serological and imaging effects of the first-line treatment group and the second-line treatment group were compared. The Fisher exact test was used to analyze the differences between groups.Results:The follow-up time of 17 patients was 17.3(9.5, 21.4) months, and the objective response rate (ORR) and disease control rate (DCR) were 7/17 and 16/17, respectively. There were no significant differences of ORR (6/13 vs 1/4; P=0.603) and DCR (13/13 vs 3/4; P=0.235) between the first-line and second-line treatment groups. The change rates of serum Tg at 3, 6 weeks and the last follow-up were -30.2%(-61.2%, -15.5%), -64.8%(-90.6%, -32.3%), and -85.8%(-96.1%, -50.7%), respectively. At the last follow-up, the change rate of maximum diameter of target lesions was -20.0%(-45.0%, -5.2%). The incidence of treatment-related adverse reactions was 14/17, and 2 patients (2/17) had grade 3 or above adverse reactions. Conclusion:Anlotinib shows superior efficacy with tolerable toxicity in the first-line treatment of distant metastatic RAIR-DTC, and hopefully plays an important role in second-line treatment for RAIR-DTC resistant to sorafenib.

Predictive value of cellular immune status before initial 131I treatment for treatment response in young and middle-aged patients with papillary thyroid cancer / 中华核医学与分子影像杂志

Objective:To investigate the value of cellular immune status before initial 131I treatment for predicting treatment response in young and middle-aged patients with papillary thyroid cancer (PTC). Methods:From March 2018 to April 2019, 150 young and middle-aged patients with PTC (46 males, 104 females, age (40.0±9.8) years) who underwent total thyroidectomy and neck lymph node dissection in the Affiliated Hospital of Qingdao University were enrolled retrospectively. All patients underwent radioablation 1-2 months after operation, and the serum lymphocyte subsets (CD3 + , CD4 + , CD8 + , CD4/CD8) as well as natural killer (NK) cells were detected 1 d before the initial 131I treatment. Patients were divided into excellent response (ER) group and non-ER group according to the response of 6-12 months after 131I treatment. Clinicopathological characteristics, preablative stimulated thyroglobulin (psTg), initial 131I dose and lymphocyte subsets that might affect the response to 131I treatment were analyzed (independent-sample t test, Mann-Whitney U test, χ2 test, multiple logistic regression analysis). ROC curve analysis was used to evaluate the predictive value of significant factors for non-ER. Results:Of 150 patients, 84 cases were in ER group (56.00%), and 66 cases (44.00%) were in non-ER group. Age ( z=-2.86, P=0.004), M stage ( χ2=13.64, P<0.001), psTg ( z=-8.94, P<0.001), initial 131I dose ( z=-7.60, P<0.001), CD4 + ( t=2.50, P=0.014), CD4/CD8 ( z=-2.22, P=0.027) of the two groups were significantly different. Multivariate analysis showed that psTg (odds ratio ( OR)=1.27, 95% CI: 1.16-1.40, P<0.001) and CD4/CD8 ( OR=0.39, 95% CI: 0.15-0.99, P=0.048) were independent factors for predicting 131I treatment response. The cut-off values of psTg and CD4/CD8 for predicting non-ER were 6.78 μg/L and 1.67, respectively. Conclusions:Cellular immune status before initial 131I treatment may predict treatment response in young and middle-aged patients with PTC. It indicates non-ER response when Tg is higher than 6.78 μg/L and CD4/CD8 is lower than 1.67.

Value of 99Tc m-MIBI SPECT/CT imaging in preoperative diagnosis of primary hyperparathyroidism and its influencing factors / 中华核医学与分子影像杂志

Objective:To investigate the preoperative diagnostic value of 99Tc m-methoxyisobutylisonitrile (MIBI) planar imaging and SPECT/CT imaging for primary hyperparathyroidism (PHPT), and analyze the relevant factors affecting the imaging results. Methods:From June 2016 to September 2019, a total of 62 patients (15 males, 47 females, age range: 27-80 years) confirmed as PHPT by postsurgical pathology in Affiliated Hospital of Qingdao University were retrospectively enrolled. The diagnostic efficacies of 99Tc m-MIBI planar imaging and SPECT/CT imaging were compared using χ2 test. The differences of preoperative serum parathyroid hormone (PTH), Ca and the maximum diameter of lesion between the positive and negative groups of planar imaging were analyzed using independent-sample t test and Mann-Whitney U test. The region of interest (ROI) method was applied to calculate the uptake ratio of lesions to normal tissues at the early phase (T/Ne) and delayed phase (T/Nd) in positive cases of planar imaging. Pearson or Spearman correlation analysis was used to evaluate the correlation of T/Ne, T/Nd with preoperative serum PTH, Ca and the maximum diameter of lesion. The receiver operating characteristic (ROC) curves of preoperative serum PTH, Ca and positive planar imaging were drawn and the cut-off values were obtained. Results:The sensitivity of planar imaging and SPECT/CT imaging was 69.35%(43/62) and 87.10%(54/62) respectively ( χ2=5.729, P=0.017). The preoperative serum PTH, Ca levels and the maximum diameter of lesion in patients with positive planar imaging (253.32(107.00, 331.70) ng/L, 2.78(2.51, 2.87) mmol/L, (2.01±0.88) mm) were higher than those with negative planar imaging ((111.86±44.29) ng/L, (2.59±0.21) mmol/L, (1.42±0.55) mm; z values: -2.802, -1.978, t=3.300, all P<0.05). T/Ne was positively correlated with preoperative serum PTH ( rs=0.511, P<0.001) and the maximum diameter of lesion ( r=0.381, P=0.012), and T/Nd was positively correlated with preoperative serum PTH ( rs=0.538, P<0.001), Ca ( rs=0.348, P=0.022) and the maximum diameter of lesion ( r=0.463, P=0.002). The area under the ROC curve between preoperative serum PTH, Ca and planar imaging was 0.725 and 0.646, respectively. Preoperative serum PTH had a better predictive value with the optimal cut-off value of 150.4 ng/L. Conclusions:Preoperative serum PTH, Ca and the maximum diameter of lesion are positively correlated with 99Tc m-MIBI uptake in PHPT patients with positive planar imaging results. When preoperative serum PTH is lower than 150.4 ng/L, planar imaging is prone to false negative. SPECT/CT imaging has a significant value in preoperative diagnosis and the combination of PTH and CT can improve the positive rate.

Treatment response of differentiated thyroid carcinoma with negative preablative stimulated thyroglobulin and iodine-positive lymph node after the first radioablation and influence factors analysis / 中华核医学与分子影像杂志

Objective@#To investigate the response to 131I therapy and to explore the influence factors in postoperative differentiated thyroid carcinoma (DTC) patients with negative preablative stimulated thyroglobulin (psTg) and iodine-positive lymph node after the first radioablation.@*Methods@#From May 2016 to October 2018, 108 DTC patients (28 males, 80 females, age: (45.7±10.4) years) with negative psTg who underwent 131I treatment for the first time in the Affiliated Hospital of Qingdao University were retrospectively enrolled. All patients had iodine-positive lymph nodes, which were showed by SPECT/CT imaging 5-6 d after 131I treatment. The treatment response was evaluated at 6-24 month after 131I treatment. Patients were divided into excellent response (ER) group and non-excellent response (non-ER) group according to the response to the first 131I treatment. Independent-sample t test, χ2 test and Mann-Whitney U test were used to analyze differences of factors (e.g. age, gender, extraglandular infiltration) between the 2 groups, and then multivariate logistic regression was performed to find the influence factors for treatment response. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of the iodine-positive lymph node size in 131I treatment response.@*Results@#A total of 82 patients (75.93%, 82/108) achieved ER, and 26 (24.07%, 26/108) was non-ER patients. There were significant differences in age (t=-2.540, P=0.016), extraglandular infiltration (χ2=5.764, P=0.016), T stage (χ2=19.857, P<0.001), N stage (χ2=14.145, P=0.001), risk stratification of recurrence (χ2=11.487, P=0.003), ultrasound results before 131I treatment (χ2=44.819, P<0.001), dose of the first 131I treatment (U=780.0, P=0.018), size (long diameter) of iodine-positive lymph node (U=184.0, P<0.001), and psTg level (U=776.0, P=0.037) between ER and non-ER groups. Multivariate logistic regression showed that age, size of iodine-positive lymph node and ultrasound results before 131I treatment were closely related to 131I treatment response. The odds ratio (OR) values (95% CI) were 1.123 (1.025-1.231), 4.275 (1.893-9.653) and 260.86 (8.123-8 376.764), respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for non-ER were 100%(26/26), 70.73%(58/82), 77.78%(84/108), 52.00%(26/50) and 100%(58/58) respectively when the cut-off value of iodine-positive lymph node size was 5.5 mm.@*Conclusion@#The response of some DTC patients with negative psTg and iodine-positive lymph node after the first radioablation were non-ER. Age, ultrasound results before 131I treatment and size of iodine-positive lymph node are sensitive indicators for predicting clinical outcome in DTC patients with negative psTg and iodine-positive lymph node after the first radioablation.

Treatment response of differentiated thyroid carcinoma with negative preablative stimulated thyroglobulin and iodine-positive lymph node after the first radioablation and influence factors analysis / 中华核医学与分子影像杂志

Objective To investigate the response to 131I therapy and to explore the influence factors in postoperative differentiated thyroid carcinoma (DTC) patients with negative preablative stimulated thyroglobulin (psTg) and iodine-positive lymph node after the first radioablation.Methods From May 2016 to October 2018,108 DTC patients (28 males,80 females,age:(45.7±10.4) years) with negative psTg who underwent 131I treatment for the first time in the Affiliated Hospital of Qingdao University were retrospectively enrolled.All patients had iodine-positive lymph nodes,which were showed by SPECT/CT imaging 5-6 d after 131I treatment.The treatment response was evaluated at 6-24 month after 131I treatment.Patients were divided into excellent response (ER) group and non-excellent response (non-ER) group according to the response to the first 131I treatment.Independent-sample t test,x2 test and Mann-Whitney U test were used to analyze differences of factors (e.g.age,gender,extraglandular infiltration) between the 2 groups,and then multivariate logistic regression was performed to find the influence factors for treatment response.The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of the iodine-positive lymph node size in 131I treatment response.Results A total of 82 patients (75.93％,82/108) achieved ER,and 26 (24.07％,26/108) was non-ER patients.There were significant differences in age (t=-2.540,P=0.016),extraglandular infiltration (x2 =5.764,P=0.016),T stage (x2=19.857,P＜0.001),N stage (x2 =14.145,P =0.001),risk stratification of recurrence (x2 =11.487,P=0.003),ultrasound results before 131I treatment (x2 =44.819,P＜0.001),dose of the first 131 I treatment (U =780.0,P =0.018),size (long diameter) of iodine-positive lymph node (U=184.0,P＜0.001),and psTg level (U=776.0,P=0.037) between ER and non-ER groups.Multivariate logistic regression showed that age,size of iodine-positive lymph node and ultrasound results before 131I treatment were closely related to 131I treatment response.The odds ratio (OR) values (95％ CI) were 1.123 (1.025-1.231),4.275 (1.893-9.653) and 260.86 (8.123-8376.764),respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value for non-ER were 100％ (26/26),70.73％ (58/82),77.78％ (84/108),52.00％ (26/50) and 100％ (58/58) respectively when the cut-off value of iodine-positive lymph node size was 5.5 mm.Conclusion The response of some DTC patients with negative psTg and iodine-positive lymph node after the first radioablation were non-ER.Age,ultrasound results before 131I treatment and size of iodine-positive lymph node are sensitive indicators for predicting clinical outcome in DTC patients with negative psTg and iodine-positive lymph node after the first radioablation.

Comparison of fine-needle aspiration cytology, ultrasound and thyroglobulin examination for the differential diagnosis of enlarged neck lymph nodes in patients with differentiated thyroid cancer after radioactive iodine remnant ablation / 中华核医学与分子影像杂志

Objective To compare the value of fine-needle aspiration cytology (FNAC),Tg,TgAb and ultrasonography (US) for the differential diagnosis of lymph node metastasis in patients with DTC after operation and radioactive iodine remnant ablation.Methods A total of 61 DTC patients with enlarged lymph nodes detected by US or physical examination after operation and radioactive iodine remnant ablation were included.FNAC was performed on the lymph nodes under US guidance within one week and the results were compared with those of Tg,TgAb and US.Final results were confirmed by comprehensive FNAC,posttreatment whole,body scan (Rx-WBS) and clinical follow-up.x2 test and Fisher's exact test were performed.Resuits Fifty-eight DTC patients had successful FNAC results,and 40 patients were confirmed as malignant and 18 as benign after overall assessment.FNAC identified 39 malignant and 19 benign cases.The coincidence rates of FNAC with postoperative pathological diagnosis and Rx-WBS for malignant cases were 100％ (20/20) and 78.9％ (15/19),respectively.For the benign cases,the coincidence rates of FNAC with clinical follow-up and Rx-WBS were 93.3％ (14/15)and 4/4,respectively.The sensitivity,specificity and accuracy were 97.5％(39/40),100％(18/18) and 98.3％(57/58) for FNAC; 87.5％(35/40),55.6％(10/18) and 77.6％(45/58) for US; 92.5％(37/40),72.2％(13/18) and 86.2％(50/58) for Tg combined with TgAb (Tg/TgAb).The accuracy of FNAC was higher than that of US and Tg/TgAb(x2 =4.336,11.697,both P＜0.05),while US and Tg/TgAb showed no significant difference (x2 =1.450,P＞0.05).Tg/TgAb and US results were consistent in 39 cases with a diagnostic accuracy of 97.4％ (38/39) verified by FNAC,while the other 19 cases with inconsistent Tg/TgAb and US results were verified as malignant in 4 cases and benign in 15 cases.Conclusions FNAC is superior to US and Tg/TgAb in the evaluation of lymph node metastasis in DTC patients after operation and radioactive iodine remnant ablation.FNAC should be recommended particularly when Tg/TgAb and US had inconsistent results.