Luca Giovanella1, Giorgio Treglia, Ramin Sadeghi, Pierpaolo Trimboli, Luca Ceriani, Frederik A Verburg. 1. Department of Nuclear Medicine and PET/CT Center (L.G., G.T., L.C.), Oncology Institute of Southern Switzerland, CH-6500 Bellinzona, Switzerland; Nuclear Medicine Research Center (R.S.), Mashhad University of Medical Sciences, 91766-99199 Mashhad, Iran; Section of Endocrinology and Diabetology (P.T.), Ospedale Israelitico, 00148 Rome, Italy; and Department of Nuclear Medicine (F.A.V.), Rheinisch-Westfällische Technische Hochschule University Hospital Aachen, 52074 Aachen, Germany.
Abstract
CONTEXT: Serum thyroglobulin (Tg) is an indicator of differentiated thyroid cancer (DTC) relapse. OBJECTIVE: Our objective was to conduct a meta-analysis of published data about the diagnostic performance of highly sensitive serum Tg (hsTg) during levothyroxine therapy in DTC follow-up. DATA SOURCES: We performed a comprehensive literature search of PubMed/MEDLINE and Scopus for studies published until July 2013. STUDY SELECTION: Studies investigating the diagnostic performance of basal hsTg in monitoring DTC were eligible. Exclusion criteria were 1) articles not within the field of interest; 2) reviews, letters, or conference proceedings; 3) articles evaluating serum Tg measurement with a functional sensitivity >0.1 ng/mL; 4) overlap in patient data; and 5) insufficient data to reassess diagnostic performance of basal serum hsTg. DATA EXTRACTION: Information was collected concerning basic study data, patient characteristics, and technical aspects. For each study, the number of true-positive, false-positive, true-negative, and false-negative findings for basal hsTg, considering stimulated Tg measurement as a reference standard, were recorded. DATA SYNTHESIS: Pooled data demonstrated that the negative predictive value of hsTg was 97% and 99% considering a stimulated Tg measurement >1 ng/mL and >2 ng/mL as cutoffs for positivity, respectively. Despite the high pooled sensitivity of basal hsTg, the pooled specificity, accuracy, and positive predictive value were insufficient to completely substitute for a stimulated Tg measurement. CONCLUSIONS: Basal hsTg measurement has a very high negative predictive value but an insufficient positive predictive value for monitoring DTC patients. Therefore, a Tg stimulation test can be avoided in patients with an undetectable basal hsTg, whereas a stimulated Tg measurement should be considered when hsTg levels are detectable.
CONTEXT: Serum thyroglobulin (Tg) is an indicator of differentiated thyroid cancer (DTC) relapse. OBJECTIVE: Our objective was to conduct a meta-analysis of published data about the diagnostic performance of highly sensitive serum Tg (hsTg) during levothyroxine therapy in DTC follow-up. DATA SOURCES: We performed a comprehensive literature search of PubMed/MEDLINE and Scopus for studies published until July 2013. STUDY SELECTION: Studies investigating the diagnostic performance of basal hsTg in monitoring DTC were eligible. Exclusion criteria were 1) articles not within the field of interest; 2) reviews, letters, or conference proceedings; 3) articles evaluating serum Tg measurement with a functional sensitivity >0.1 ng/mL; 4) overlap in patient data; and 5) insufficient data to reassess diagnostic performance of basal serum hsTg. DATA EXTRACTION: Information was collected concerning basic study data, patient characteristics, and technical aspects. For each study, the number of true-positive, false-positive, true-negative, and false-negative findings for basal hsTg, considering stimulated Tg measurement as a reference standard, were recorded. DATA SYNTHESIS: Pooled data demonstrated that the negative predictive value of hsTg was 97% and 99% considering a stimulated Tg measurement >1 ng/mL and >2 ng/mL as cutoffs for positivity, respectively. Despite the high pooled sensitivity of basal hsTg, the pooled specificity, accuracy, and positive predictive value were insufficient to completely substitute for a stimulated Tg measurement. CONCLUSIONS: Basal hsTg measurement has a very high negative predictive value but an insufficient positive predictive value for monitoring DTCpatients. Therefore, a Tg stimulation test can be avoided in patients with an undetectable basal hsTg, whereas a stimulated Tg measurement should be considered when hsTg levels are detectable.
Authors: Luca Giovanella; Anca M Avram; Jerome Clerc; Elif Hindié; David Taïeb; Frederik A Verburg Journal: Eur J Nucl Med Mol Imaging Date: 2018-07-30 Impact factor: 9.236
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