Postoperative thyroglobulin as a yard-stick for radioiodine therapy: decision tree analysis in a European multicenter series of 1317 patients with differentiated thyroid cancer.

Giovanella L., Milan L., Roll W., Weber M., Schenke S., Kreissl M., ...More

European journal of nuclear medicine and molecular imaging, vol.50, no.9, pp.2767-2774, 2023 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 50 Issue: 9
  • Publication Date: 2023
  • Doi Number: 10.1007/s00259-023-06239-8
  • Journal Name: European journal of nuclear medicine and molecular imaging
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, Biotechnology Research Abstracts, CINAHL, EMBASE, MEDLINE
  • Page Numbers: pp.2767-2774
  • Keywords: Decision tree model, Differentiated thyroid cancer, DTC, Post-treatment whole-body scintigraphy, PT-WBS, Tg, Thyroglobulin
  • Hacettepe University Affiliated: Yes


Purpose: An accurate postoperative assessment is pivotal to inform postoperative 131I treatment in patients with differentiated thyroid cancer (DTC). We developed a predictive model for post-treatment whole-body scintigraphy (PT-WBS) results (as a proxy for persistent disease) by adopting a decision tree model. Methods: Age, sex, histology, T stage, N stage, risk classes, remnant estimation, TSH, and Tg were identified as potential predictors and were put into regression algorithm (conditional inference tree, ctree) to develop a risk stratification model for predicting the presence of metastases in PT-WBS. Results: The lymph node (N) stage identified a partition of the population into two subgroups (N-positive vs N-negative). Among N-positive patients, a Tg value > 23.3 ng/mL conferred a 83% probability to have metastatic disease compared to those with lower Tg values. Additionally, N-negative patients were further substratified in three subgroups with different risk rates according to their Tg values. The model remained stable and reproducible in the iterative process of cross validation. Conclusions: We developed a simple and robust decision tree model able to provide reliable informations on the probability of persistent/metastatic DTC after surgery. These information may guide post-surgery 131I administration and select patients requiring curative rather than adjuvant 131I therapy schedules.