2018, Número 4
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Rev Mex Patol Clin Med Lab 2018; 65 (4)
Resultados discordantes de tiroglobulina y gammagrafía en pacientes operados de cáncer de tiroides
Marrero MT, Sinconegui B
Idioma: Español
Referencias bibliográficas: 29
Paginas: 206-210
Archivo PDF: 275.32 Kb.
RESUMEN
En la asistencia médica podemos encontrar casos discordantes en el seguimiento de pacientes con cáncer diferenciado de tiroides (CDT), ya sea pacientes con niveles de tiroglobulina (Tg) bajos, con gammagrafía positiva o pacientes con niveles de Tg elevada y gammagrafía negativa. El objetivo del trabajo fue evaluar el comportamiento de los niveles de tiroglobulina y gammagrafía en pacientes operados de CDT.
Material y métodos: Se realizó un estudio retrospectivo en 148 pacientes operados de CDT. El seguimiento incluyó gammagrafía con yodo-131 y la determinación de tiroglobulina, anticuerpos antitiroglobulina y hormona estimuladora del tiroides. Se utilizó la prueba de correlación de Pearson para estudiar la asociación entre las variables.
Resultados: 52.7% de los casos correspondió a resultados discordantes: 5.1% con niveles séricos de Tg bajos y gammagrafía positiva y 94.9% niveles de Tg elevados y gammagrafía negativa.
Conclusiones: Los estudios de gammagrafía y de Tg no se correlacionaron en 78 pacientes estudiados (52.7%). La mayor cantidad de los casos discordantes correspondió a valores de Tg positiva y gammagrafía negativa. Conocer las posibles causas de estas discordancias, así como las limitaciones de cada procedimiento diagnóstico, ayudará a un seguimiento más eficaz de estos pacientes.
REFERENCIAS (EN ESTE ARTÍCULO)
Liu Z, Zeng W, Liu C, Wang S, Xiong Y, Guo Y et al. Diagnostic accuracy of ultrasonographic features for lymph node metastasis in papillary thyroid microcarcinoma: a single-center retrospective study. World J Surg Oncol. 2017; 15: 32.
Davies L, Morris L, Hankey B. Increases in thyroid cancer incidence and mortality. JAMA. 2017; 318: 389-390.
Zheng R, Zeng H, Zhang S, Chen W. Estimates of cancer incidence and mortality in China, 2013. Chin J Cancer. 2017; 36: 66.
Mao Y, Xing M. Recent incidences and differential trends of thyroid cancer in the USA. Endocr Relat Cancer. 2016; 23: 313-322.
Liao S, Shindo M. Management off well-differentiated thyroid cancer. Otolaryngology Clinics. 2012; 45: 1163-1179.
Pacini F, Castagna MG, Brilli L. Pentheroudakis. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Clinical practical guidelines. Annals of Oncology. 2012; 23 (Supplement 7): vii110-vii119.
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Niki-forov YE et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016; 26: 1-133.
Giovanella L, Treglia G, Sadeghi R, Trimboli P, Ceriani L, Verburg FA. Unstimulated highly sensitive thyroglobulin in follow-up of differentiated thyroid cancer patients: a meta- analysis. J Clin Endocrinol Metab. 2014; 99: 440-447.
Giovanella L, Clark PM, Chiovato L, Duntas L, Elisei R, Feldt-Rasmussen U et al. Thyroglobulin measurement using highly sensitive assays in patients with differentiated thyroid cancer: a clinical position paper. Eur J Endocrinol. 2014; 171: 33-46.
Cooper D, Doherty G, Haugen B, Kloos R, Lee S et al. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2009; 19 (11): 1167.
Garger YB, Winfeld M, Friedman K, Blum M. In thyroidectomized thyroid cancer patients, false-positive I-131 whole body scans are often caused by inflammation rather than thyroid cancer. J Investig Med High Impact Case Rep. 2016; 4 (1): 2324709616633715.
Glazer DI, Brown RKJ, Wong KK, Savas H, Gross MD, Avram AM. SPECT/CT evaluation of unusual physiologic radioiodine biodistributions: pearls and pitfalls in image interpretation. Radiographics. 2013; 33 (2): 397-418.
Kara PO, Gunay EC, Erdogan A. Radioiodine contamination artifacts and unusual patterns of accumulation in whole-body I-131 imaging: a case series. Int J Endocrinol Metab. 2014; 12 (1): e9329.
Black EG, Sheppard MC, Hoffenberg R. Serial serum thyroglobulin measurement in the management of differentiated thyroid carcinoma. Clin Endocrinol. 1987; 13: 107-10.
Franceschi M, Kusic Z, Franceschi D, Lukinac L, Roncevic S. Thyroglobulin determination, neck ultrasonography and iodine-131 whole-body scintigraphy in differentiated thyroid carcinoma. J Nucl Med. 1996; 37: 446-451.
Chao M et al. Management of differentiated thyroid cancer with rising thyroglobulin and negative diagnostic radioiodine whole body scan. Clinical Oncology. 2010; 22: 438-447.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017; 67: 7-30.
McLeod DS, Cooper DS, Ladenson PW et al. Prognosis of differentiated thyroid cancer in relation to serum thyrotropin and thyroglobulin antibody status at time of diagnosis. Thyroid. 2014; 24: 35-42.
Rosario PW, Mineiro Filho AF, Prates BS, Silva LC, Calsolari MR. Postoperative stimulated thyroglobulin of less than 1 ng/mL as a criterion to spare low-risk patients with papillary thyroid cancer from radioactive iodine ablation. Thyroid. 2012; 22: 1140-1143.
Sinconegui B, Marrero MT. Anticuerpos antitiroglobulina en la determinación de tiroglobulina en el seguimiento de pacientes operados de cáncer diferenciado de tiroides. Rev. Latinoamer Patol Clin. 2013; 60 (1): 52-56.
Girelli ME, Busnardo B, Amerio R, Casara D, Betterle C, Piccolo M. Critical evaluation of serum thyroglobulin (Tg) levels during thyroid hormone suppression therapy versus Tg levels after hormone withdrawal and total body scan: Results in 291 patients with thyroid cancer. Eur J Nucl Med. 1986; 11: 333-335.
Brendel AJ, Lambert B, Guyot M, Jeandot R, Dubourg H, Roger P et al. Low levels of serum thyroglobulin after withdrawal of thyroid suppression therapy in the follow up of differentiated thyroid carcinoma. Eur J Nucl Med. 1990; 16: 35-38.
Kim PS, Dunn AD, Dunn JT. Altered immunoreacti-vity of thyroglobulin in thyroid disease. J Clin Endocrinol Metab. 1988; 67: 161-168.
Velasco S, Solar A, Cruz F, Quintana JC, León A, Mosso L et al. Tiroglobulina y sus limitaciones en el seguimiento del carcinoma diferenciado del tiroides. Rev Méd Chile. 2007; 135: 506-511.
Bertaux F, Noel M, Lasmoles F, Fragu P. Identification of the exon structure and four alternative transcripts of the thyroglobulin-encoding gene. Gene. 1995; 156: 297-301.
Silberschmidt D, Rodriguez-Malton A, Cal G, Amendola E et al. In vivo role of different domains and of phosphorilation in the transcription factor NKx2-1 BMC Development Biology. 2011.
Haugen BR, Pacini F, Reiners C, Schlumberger M, Ladenson PW, Sherman SI et al. A comparison of recombinant human thyrotropin and thyroid hormone withdrawal for the detection of thyroid remnant or cancer. J Clin Endocrinol Metab. 1999; 84: 3877-3885.
Shammas AD, Mountz JM, McCook BM, Branstetter B, Bencherif B et al. 18F-FDG PET/CT in patients with suspected recurrent o metastatic well-differentiated thyroid cancer. Journal of Nuclear Medecine: official publication, Society of Nuclear Medicine. 2007; 48: 221-226.
Leboulleux S et al. Postradioiodine treatment whole-body scan in the era of .18-fluorodeoxyglucose positron emission tomography for differentiated thyroid carcinoma with elevated serum thyroglobulin levels. Thyroid. 2012; 22: 832-838.