Treatment
20
Diagnostic RAI Whole-body Scans (WBS)
Recommendation 49
A. Patients who have undergone lobectomy or total thyroidectomy
without RAI should not undergo surveillance radioiodine WBS. (GPS)
B. Patients with DTC who are at low- and low-intermediate risk of
recurrence and who have excellent response to therapy do not require
routine diagnostic radioiodine WBS during follow-up. (C-L)
C. Patients with DTC who are at intermediate-high and high-risk of
recurrence can be evaluated with diagnostic radioiodine WBS to
evaluate for iodine-avid disease if there is clinical suspicion for
recurrence. WBS, if undertaken, can be performed with
123
I or low
activity
131
I. (C-L)
D. SPECT-CT radioiodine imaging may be performed in addition to
planar imaging to anatomically localize the radioiodine uptake and
distinguish between likely cancer and nonspecific uptake. (C-L)
18
FDG-PET/CT Scanning
Recommendation 50
A. Imaging using
18
FDG-PET/CT scanning may be performed in DTC
patients at high-risk of recurrence with elevated serum Tg levels,
particularly in patients with OTC or aggressive histologies and in
patients who have a history of negative RAI imaging. (C-M)
B. Imaging with
18
FDG-PET/CT scanning may also be employed:
1) as a prognostic tool in patients at highest risk for rapid disease
progression and disease-specific mortality, and
2) as an evaluation of post-treatment response following systemic or
local therapy of invasive disease. (C-L)
Recommendation 51
➤ Ongoing risk stratification (dynamic risk assessment), when used in
combination with the initial risk of recurrence, allows the clinician
to provide individualized management recommendations while risk
estimates evolve over time and should be used to inform timing and
type of imaging. (GPS)
