Document Detail

Remnant uptake as a postoperative oncologic quality indicator.
MedLine Citation:
PMID:  23373869     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The purpose of this study was to examine the utility of remnant uptake on postoperative radioiodine scans as an oncologic indicator after thyroidectomy for differentiated thyroid cancer (DTC).
METHODS: We conducted a retrospective review of patients undergoing total thyroidectomy for DTC and subsequent radioactive iodine (RAI) treatment. Of the eight surgeons included, three were considered high volume, performing at least 20 thyroidectomies per year. Patients with distant metastases at diagnosis or poorly differentiated variants were excluded. To control for the effect of varying RAI doses, the remnant uptake was analyzed as a ratio of the percentage uptake to the dose received (uptake to dose ratio [UDR]). Multivariate logistic regression was used to determine the influence of UDR on recurrence.
RESULTS: Of the 223 patients who met inclusion criteria, 21 patients (9.42%) experienced a recurrence. Those with a recurrence had a 10-fold higher UDR compared with those who did not (0.030 vs. 0.003, p=0.001). Similarly, patients with increasing postoperative thyroglobulin measurements (0.339 vs. 0.003, p<0.001) also had significantly greater UDRs compared with those with stable thyroglobulin. The UDRs of high-volume surgeons were significantly smaller than low-volume surgeons (0.003 vs. 0.025, p=0.002). When combined with other known predictors for recurrence, UDR (OR 3.71 [95%CI 1.05-13.10], p=0.041) was significantly associated with recurrence. High-volume surgeons maintained a low level of permanent complications across all UDRs, whereas low-volume surgeons had greater permanent complications associated with higher uptake.
CONCLUSIONS: Remnant uptake is a useful postoperative oncologic quality indicator that can predict a patient's risk of disease recurrence and indicate the completeness of resection.
David F Schneider; Kristin A Ojomo; Herbert Chen; Rebecca S Sippel
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2013-07-17
Journal Detail:
Title:  Thyroid : official journal of the American Thyroid Association     Volume:  23     ISSN:  1557-9077     ISO Abbreviation:  Thyroid     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-09-25     Completed Date:  2014-04-30     Revised Date:  2014-10-12    
Medline Journal Info:
Nlm Unique ID:  9104317     Medline TA:  Thyroid     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1269-76     Citation Subset:  IM    
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MeSH Terms
Cohort Studies
Combined Modality Therapy / adverse effects
Follow-Up Studies
Iodine Radioisotopes / adverse effects,  diagnostic use,  pharmacokinetics*,  therapeutic use
Middle Aged
Neck / radiation effects,  radionuclide imaging*,  surgery
Neoplasm Recurrence, Local / prevention & control
Postoperative Complications / prevention & control
Postoperative Period
Quality Indicators, Health Care*
Radiopharmaceuticals / adverse effects,  diagnostic use,  pharmacokinetics*,  therapeutic use
Retrospective Studies
Survival Analysis
Thyroid Gland / radiation effects,  radionuclide imaging*,  surgery
Thyroid Neoplasms / diagnosis,  prevention & control,  radionuclide imaging*,  therapy
Thyroidectomy* / adverse effects
Tissue Distribution
Grant Support
T32 CA009614-23/CA/NCI NIH HHS
Reg. No./Substance:
0/Iodine Radioisotopes; 0/Radiopharmaceuticals
Comment In:
Chirurg. 2014 Mar;85(3):256   [PMID:  24496752 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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