Five months' follow-up of patients with and without iodine-positive lymph node metastases of thyroid carcinoma as disclosed by (131)I-SPECT/CT at the first radioablation

Eur J Nucl Med Mol Imaging. 2010 Apr;37(4):699-705. doi: 10.1007/s00259-009-1299-2. Epub 2009 Nov 20.


Purpose: In differentiated thyroid carcinoma (DTC), (131)I-SPECT/CT is more accurate in identifying radioiodine-positive lymph node metastases (LNM) than planar whole-body scans (WBS). The purpose of this study was to investigate the value of (131)I-SPECT/CT performed at the first radioablation to predict the occurrence and/or persistence of cervical radioiodine-positive LNM 5 months later.

Methods: The study included 81 DTC patients that had had SPECT/ spiral CT after radioablation of thyroid remnants after thyroidectomy. The patients were re-examined 5 months later using (131)I-WBS performed at TSH stimulation. In addition, SPECT/CT of the neck was performed in patients with iodine-positive cervical foci to distinguish between thyroid remnant and LNM. The outcome variable of the study was the detection or exclusion of iodine-positive cervical LNM.

Results: Of 61 patients without a SPECT/CT diagnosis of (131)I-positive LNM at radioablation, 60 had no (131)I-positive LNM at follow-up. In the remaining patient of this group, a new radioiodine-positive LNM was detected. In 17 of 20 patients with a SPECT/CT diagnosis of (131)I-positive LNM (n = 19) or an indeterminate lesion (n = 1) at first radioablation, no (131)I-positive LNM were detected 5 months later. Radioiodine-positive LNM persisted in three patients of this group.

Conclusion: (131)I-SPECT/CT has a high negative predictive value with regard to the occurrence of radioiodine-positive cervical LNM 5 months after initial therapy. The majority of iodine-positive LNM diagnosed by SPECT/CT at radioablation disappear within 5 months. These findings motivate further research into the value of (131)I-SPECT/CT of the neck for predicting recurrence and planning surgical reintervention in DTC.

Publication types

  • Comparative Study

MeSH terms

  • Adenocarcinoma, Follicular / diagnostic imaging
  • Adenocarcinoma, Follicular / radiotherapy
  • Adenocarcinoma, Follicular / secondary*
  • Adenocarcinoma, Follicular / surgery
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Papillary / diagnostic imaging
  • Carcinoma, Papillary / radiotherapy
  • Carcinoma, Papillary / secondary*
  • Carcinoma, Papillary / surgery
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Iodine Radioisotopes / therapeutic use*
  • Lymphatic Metastasis / diagnostic imaging*
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / diagnostic imaging
  • Neoplasm, Residual
  • Patient Care Planning
  • Predictive Value of Tests
  • Radiopharmaceuticals / therapeutic use*
  • Reoperation
  • Thyroid Neoplasms / pathology*
  • Thyroidectomy
  • Tomography, Emission-Computed, Single-Photon*
  • Tomography, Spiral Computed*
  • Whole Body Imaging
  • Young Adult


  • Iodine Radioisotopes
  • Radiopharmaceuticals