Predictive Value of Recombinant Human TSH Stimulation and Neck Ultrasonography in Differentiated Thyroid Cancer Patients

作者：Umberto Crocetti, Cosimo Durante, Marco Attard, Adele Maniglia, Dario Tumino, Rocco Bruno, Nazario Bonfitto, Franca Dicembrino, Antonio Varraso, Domenico Meringolo, Sébastiano Filetti, Vincenzo Trischitta, Massimo Torlontano · 发表于：Thyroid · 年份：2008 · DOI：10.1089/thy.2008.0160 · 被引用次数：43 · 研究领域：Thyroid Cancer Diagnosis and Treatment、Thyroid Disorders and Treatments、Thyroid and Parathyroid Surgery

BACKGROUND: Serum thyroglobulin (Tg) stimulation by recombinant human TSH (rhTSH), in combination with neck ultrasonography (US), is an important tool in the first follow-up of differentiated epithelial cell thyroid carcinoma (DTC) patients. The objective of this study was to investigate if a second rhTSH stimulation, performed 2-3 years later, is of clinical utility in the follow-up of these patients. METHODS: One hundred and one consecutive ambulatory DTC patients were studied. The great majority of them (89/101) were low-risk patients, being stage I or II at tumor node metastasis (TNM) staging classification. All study patients had been treated by surgery and radioiodine ablation, and exhibited, at first rhTSH follow-up, either undetectable Tg ( 1-5 ng/mL) (rhTSH1-Tg+, n = 12 patients considered with uncertain prognosis), with no US evidence of residual disease. In all patients, serum Tg measurement after a second rhTSH stimulation and neck US were performed. RESULTS: At the second follow-up, all 89 rhTSH1-Tg-patients showed a negative US, and Tg became low positive only in one case, whereas it remained undetectable in the other patients. The overall negative predictive value of rhTSH1-Tg- was, then, 98.9%. Out of the remaining 12 patients (i.e., rhTSH1-Tg+ patients), 2 showed disease persistence/recurrence (with a positive predictive value of rhTSH1-Tg+ of 16.7%) and 6 became Tg-. CONCLUSIONS: A second rhTSH stimulation is useless in DTC patients who were rhTSH-Tg and ima...