Los protocolos de tratamiento y seguimiento del carcinoma diferenciado de tiroides: resultados de un cuestionario enviado a las Unidades de Terapia Metabólica españolas / Treatment protocols and follow-up of differentiated thyroid carcinoma: results of a questionnaire sent to the Spanish Metabolic Therapy Units

Objetivos. Conocer los protocolos de tratamiento y seguimiento del carcinoma diferenciado de tiroides en las Unidades de Terapia Metabólica españolas, la variabilidad de los mismos y la adaptación a las guías de consenso. Material y métodos. Análisis de los resultados de un cuestionario remitido por e-mail a los miembros de la Sociedad Española de Medicina Nuclear e Imagen Molecular (SEMNIM) sobre tratamiento y seguimiento del carcinoma diferenciado de tiroides. Estudio descriptivo, de variables cualitativas (frecuencias, porcentajes) y cuantitativas (media, desviación típica). Resultados. Veinte Unidades de Terapia respondieron la encuesta. Aunque hay dispersión en la procedencia de los pacientes, las Unidades reciben suficiente información y cuentan con cirujanos especializados. Hay variabilidad en los protocolos quirúrgicos e indicación de ablación en pacientes de riesgo bajo e intermedio. Hay acuerdo en las dosis de 131I administradas en ablación y tratamiento, pero una gran variabilidad en el protocolo de preparación (rastreo y dosis, otras técnicas de imagen, dieta y prohibición de contrastes yodados, dosis total por paciente). Se perciben las complicaciones del radioyodo y se utilizan sistemas de prevención. El seguimiento de los pacientes postablación es muy variado. Conclusiones. Los protocolos de tratamiento y seguimiento del carcinoma diferenciado de tiroides en las Unidades de Terapia Metabólica con 131I españolas muestran variabilidad en aspectos como el tipo de cirugía e indicación de la ablación, la preparación de los pacientes para el tratamiento con radioyodo, y el seguimiento, existiendo muchos aspectos en los que nos separamos de lo recomendado en las recientes guías de consenso(AU)

Objective. To know the treatment and follow-up protocols of differentiated thyroid carcinoma patients in Spanish Metabolic Therapy Units, the clinical variability between them and the adaptation to the consensus guidelines. Materials and methods. Analysis of the results obtained from the questionnaire submitted by E-mail to the Spanish Society of Nuclear Medicine (SEMNIM) members on the treatment and follow-up of differentiated thyroid carcinoma patients. A descriptive study was made of the qualitative variables (frequency, percentage) and quantitative variables (mean, standard deviation). Results. Twenty Radiometabolic Therapy Units responded to the questionnaire. In spite of the varied origin of the patients, the Units receive sufficient clinical information and have specialized surgeons. There is variability in the surgical protocols and indication for ablation in patients with intermediate and low risk of recurrence. The Units agree on the use of 131I doses for ablation and therapy, but show great variability regarding the preparation protocols (previous 131I-whole body scan or other imaging techniques, 131I-whole body scan dose, diet and radioiodine contrast prohibition, total dose per patient). Nuclear Medicine physicians perceive radioiodine adverse effects and prevention methods are used. The post-ablation follow-up protocol differs between Units. Conclusions. Treatment and follow-up protocols of differentiated thyroid carcinoma patients in the Spanish Radiometabolic Therapy Units show variability in aspects such as surgery and ablation indications, patient preparation for radioiodine therapy and follow-up. Our clinical practice differs in several aspects from the recent consensus guideline recommendations(AU)

[Treatment protocols and follow-up of differentiated thyroid carcinoma: results of a questionnaire sent to the Spanish Metabolic Therapy Units]. / Los protocolos de tratamiento y seguimiento del carcinoma diferenciado de tiroides: resultados de un cuestionario enviado a las Unidades de Terapia Metabólica españolas.

OBJECTIVE: To know the treatment and follow-up protocols of differentiated thyroid carcinoma patients in Spanish Metabolic Therapy Units, the clinical variability between them and the adaptation to the consensus guidelines. MATERIALS AND METHODS: Analysis of the results obtained from the questionnaire submitted by E-mail to the Spanish Society of Nuclear Medicine (SEMNIM) members on the treatment and follow-up of differentiated thyroid carcinoma patients. A descriptive study was made of the qualitative variables (frequency, percentage) and quantitative variables (mean, standard deviation). RESULTS: Twenty Radiometabolic Therapy Units responded to the questionnaire. In spite of the varied origin of the patients, the Units receive sufficient clinical information and have specialized surgeons. There is variability in the surgical protocols and indication for ablation in patients with intermediate and low risk of recurrence. The Units agree on the use of (131)I doses for ablation and therapy, but show great variability regarding the preparation protocols (previous (131)I-whole body scan or other imaging techniques, (131)I-whole body scan dose, diet and radioiodine contrast prohibition, total dose per patient). Nuclear Medicine physicians perceive radioiodine adverse effects and prevention methods are used. The post-ablation follow-up protocol differs between Units. CONCLUSIONS: Treatment and follow-up protocols of differentiated thyroid carcinoma patients in the Spanish Radiometabolic Therapy Units show variability in aspects such as surgery and ablation indications, patient preparation for radioiodine therapy and follow-up. Our clinical practice differs in several aspects from the recent consensus guideline recommendations.

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The diagnostic value of Tc-99m human polyclonal immunoglobulin imaging compared to Tc-99m HMPAO labeled leukocytes in inflammatory bowel disease.

The aim of this study was to establish the usefulness of Tc-99m human polyclonal immunoglobulin (HIG) imaging in a group of patients who were suspected of having inflammatory bowel disease (IBD). The authors performed 30 scans (15 with Tc-99m HMPAO leukocytes and 15 with Tc-99m HIG) on 15 patients with IBD. Ten patients had Crohn's disease and five had ulcerative colitis. The sensitivity of Tc-99m HIG scintigraphy for detecting IBD was 33%, while the sensitivity of Tc-99m HMPAO leukocyte imaging was 100%. The Tc-99m HMPAO leukocyte imaging also detected a larger number of affected segments and provided better image quality of the extent of disease than Tc-99m HIG. On the basis of these results, the authors believe that Tc-99m HIG imaging is not a useful technique in the evaluation of patients with IBD, in the identification of location, or the extension or degree of disease activity.