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The Utility of Serum Thyroglobulin Measurement at the Time of Remnant Ablation for Predicting Disease-Free Status in Patients with Differentiated Thyroid Cancer: A Meta-Analysis Involving 3947 Patients.
MedLine Citation:
PMID:  22639291     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Context:Decisions regarding initial therapy and subsequent surveillance in patients with differentiated thyroid cancer (DTC) depend upon an accurate assessment of the risk of persistent or recurrent disease.Objective:The objective of this study was to examine the predictive value of a single measurement of serum thyroglobulin (Tg) just before radioiodine remnant ablation (preablation Tg) on subsequent disease-free status.Data Sources:Sources included MEDLINE and BIOSYS databases between January 1996 and June 2011 as well as data from the author's tertiary-care medical center.Study Selection:Included studies reported preablation Tg values and the outcome of initial therapy at surveillance testing or during the course of long-term follow-up.Data Extraction:Two investigators independently extracted data and rated study quality using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Reviews-2 (QUADAS-2) tool.Data Synthesis:Fifteen studies involving 3947 patients with DTC were included. Seventy percent of patients had preablation Tg values lower than the threshold value being examined. The negative predictive value (NPV) of a preablation Tg below threshold was 94.2 (95% confidence interval = 92.8-95.3) for an absence of biochemical or structural evidence of disease at initial surveillance or subsequent follow-up. The summary receiver operator characteristic curve based on a bivariate mixed-effects binomial regression model showed a clustering of studies using a preablation Tg below 10 ng/ml near the summary point of optimal test sensitivity and specificity.Conclusion:Preablation Tg testing is a readily available and inexpensive tool with a high NPV for future disease-free status. A low preablation Tg should be considered a favorable risk factor in patients with DTC. Further study is required to determine whether a low preablation Tg may be used to select patients for whom radioiodine remnant ablation can be avoided.
Authors:
Richard C Webb; Robin S Howard; Alexander Stojadinovic; David Y Gaitonde; Mark K Wallace; Jehanara Ahmed; Henry B Burch
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-25
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  -     ISSN:  1945-7197     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-5-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Departments of Surgery (R.C.W., A.S.) and Research Programs (R.S.H.), Biostatistics Division, and Endocrinology Service (H.B.B.), Department of Medicine, Walter Reed National Military Medical Center, and Uniformed Services University of Health Sciences (A.S., H.B.B.), Bethesda, Maryland 20889; United States Military Cancer Institute (A.S.), Bethesda, Maryland 20889; Endocrinology Service (D.Y.G.), Department of Medicine, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia 30905; Endocrinology Service (M.K.W.), Brooke Army Medical Center, Fort Sam Houston, Texas 78234; Southeast Medical Associates (J.A.), Beaumont, Texas 77701.
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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