Background: The identification of neck lymph node (LN) metastases represents a very important issue in the\nmanagement of patients with differentiated thyroid carcinoma (DTC). To this purpose, in the present study, we\nused 131I-SPECT/CT as a diagnostic imaging procedure.\nMethods: A consecutive series of 224 DTC patients with ascertained neck radioiodine-avid foci at 131I-SPECT/CT\nduring long-term follow-up was evaluated. All patients had already undergone total thyroidectomy and radioiodine\ntherapy and had been classified as follows: 62 at high risk (H), 64 at low risk (L) and 98 at very low risk (VL). 131IWhole\nbody scan (WBS) followed by SPECT/CT was performed in all cases.\nResults: In the 224 patients, 449 neck iodine avid foci were ascertained at SPECT/CT, while 322 were evidenced at\nWBS in 165/224 patients. WBS classified as residues 263/322 foci and as unclear 59/322 foci; among the former foci\nSPECT/CT correctly characterized 8 LN metastases and 3 physiologic uptakes and among the latter, it pinpointed 26\nLN metastases, 18 residues, and 15 physiologic uptakes. SPECT/CT also classified 127 foci occult at WBS as 59 LN\nmetastases and 68 residues. Globally, SPECT/CT identified 93 LN metastases in 59 patients (26 H, 20 L, 13 VL), while\nWBS evidenced 34 in 25 cases. All 13 VL patients, T1aN0M0, 5 of whom with LN near sub-mandibular glands, had\nthyroglobulin undetectable or < 2.5 ng/ml. Globally, SPECT/CT obtained an incremental value than WBS in 45.5% of\npatients, a more correct patient classification changing therapeutic approach in 30.3% of cases and identified WBS\nfalse-positive findings in 8% of cases.\nConclusions: 131I-SPECT/CT proved to correctly detect and characterize neck LN metastases in DTC patients in\nlong-term follow-up, improving the performance of planar WBS. SPECT/CT routine use is thus suggested; its role is\nparticularly relevant in patients with WBS inconclusive, VL, T1aN0M0 and with undetectable or very low\nthyroglobulin levels.
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