Unstimulated high-sensitive thyroglobulin is a powerful prognostic predictor in patients with thyroid cancer

  • 1 Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
  • 2 Laboratory for Endocrinology and Tumour Markers, Department of Laboratory Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
  • 3 Clinic for Nuclear Medicine, University Hospital and University of Zürich, Zürich, Switzerland
  • 4 Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
Luca GiovanellaORCID iD: https://orcid.org/0000-0003-0230-0974
  • Corresponding author
  • Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
  • Laboratory for Endocrinology and Tumour Markers, Department of Laboratory Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
  • Clinic for Nuclear Medicine, University Hospital and University of Zürich, Zürich, Switzerland
  • orcid.org/0000-0003-0230-0974
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, Marco CastellanaORCID iD: https://orcid.org/0000-0002-1175-8998 and Pierpaolo TrimboliORCID iD: https://orcid.org/0000-0002-2125-4937

Abstract

Background

Differentiated thyroid carcinoma (DTC) has an excellent prognosis and the role of high-sensitive thyroglobulin measured during levothyroxine (ON-T4 hs-Tg) testing to discriminate patients with structural from not-evidence of disease (SED and NED, respectively) has been investigated. We conducted a systematic review and meta-analysis evaluating the performance of ON-T4 hs-Tg in two clinical scenarios considering its negative predictive value (NPV) as primary outcome: (1) diagnostic performance of Tg when undetectable value and NED status are simultaneously demonstrated; (2) prognostic performance of undetectable Tg in predicting NED in the subsequent follow-up.

Methods

This systematic review and meta-analysis were registered on PROSPERO (CRD42019125092). PubMed, Scopus, CENTRAL and Web of Science were searched until February 12, 2019. Original articles reporting data on SED/NED in patients with detectable/undetectable ON-T4 hs-Tg were selected. Summary operating points were estimated using a random-effects model.

Results

Out of 1413 retrieved papers, 10 studies evaluating 1796 patients were included. Participants were outpatients diagnosed with DTC, treated with near-total (NTx) or total thyroidectomy (TTx) with or without radioactive iodine (RAI). The NPV of ON-T4 hs-Tg for diagnostic and prognostic performance was 99.4% (95% CI 98.9–99.9; I2 = 13%) and 99.4% (95% CI 98.8–100; I2 = 0%), respectively.

Conclusions

Our findings show that ON-T4 hs-Tg is an excellent diagnostic tool and prognostic factor to rule-out SED. A high level of evidence is provided to decrease the intensity and frequency of follow-up in those DTC patients having undetectable high-sensitive Tg.

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