Asia Oceania Journal of Nuclear Medicine and Biology

Asia Oceania Journal of Nuclear Medicine and Biology

Patterns of radioiodine uptake combined with pulmonary nodule size in predicting long-term clinical outcomes of differentiated thyroid carcinoma patients with lung metastasis alone

Document Type : Original Article

Authors
Thong H Mai
Khanh Q Le
Khoa B Tran
Phuong Th Nguyen
Ha N Le
Department of Nuclear Medicine, Hospital 108, Ha Noi, Vietnam
10.22038/aojnmb.2025.87406.1628
Abstract
Objective(s): This study aimed to evaluate the role of radioiodine uptake patterns and pulmonary nodule size in predicting progression- free survival (PFS) and overall survival (OS) in DTC patients with lung metastases only.
Methods: A retrospective study was conducted on 189 DTC patients with pulmonary metastasis alone who were treated and monitored at the Department of Nuclear Medicine, Hospital 108, Vietnam from January 2004 to December 2018. They were categorized based on radioiodine uptake patterns on post-therapy whole-body scans (WBS) and CT-based pulmonary nodule sizes. Prognostic factors were identified by Kaplan-Meier survival and Cox regression.
Results: The 5-year and 10-year OS rates were 96.83 % and 94.71 %. DTC-LM patients with diffuse radioiodine uptake and miliary metastases demonstrated significantly higher survival rates, with 5-year and 10-year PFS rates of 100% and 98.8%, respectively. In contrast, patients with nonavid metastases exhibited a markedly lower prognosis, with 5-year and 10-year PFS rates of 58.8% and 25.2%, respectively (p<0.001). Patients with nodules <5 mm had 5-year and 10-year PFS rates of 88.8% and 73.8%, respectively, while those with nodules 5–10 mm had rates of 79.8% and 52.7%. Patients with nodules ≥10 mm experienced the worst outcomes, with 5-year and 10-year PFS rates of 70.6% and 29.3% (p<0.001). Multivariate analysis confirmed that non-avid metastases, nodule size ≥10 mm, and age ≥55 were independent predictors of poor prognosis (HR:24.99, 5.96, and 6.58; p<0.001).
Conclusions: Patterns of radioiodine uptake and pulmonary nodule sizes on CT imaging are crucial predictors of long-term clinical outcomes in DTC-LM. Diffuse iodine uptake and military pulmonary metastases are associated with favorable outcomes, while non-avid lung nodules and larger nodule sizes predict poorer survival.
Keywords
Differentiated thyroid carcinoma
Lung metastasis
Patterns of lung radioiodine uptake
Pulmonary nodule size
Prognosis
Subjects
  1. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016; 26(1):1-33.
  2. Kim TY, Kim WG, Kim WB, Shong YK. Current status and future perspectives in differentiated thyroid cancer. Endocrinology and Metabolism. 2014; 29(3):217-25.
  3. Sampson E, Brierley JD, Le LW, Rotstein L, Tsang RW. Clinical management and outcome of papillary and follicular (differentiated) thyroid cancer presenting with distant metastasis at diagnosis. Cancer: Interdisciplinary International Journal of the American Cancer Society. 2007; 110(7): 1451-6.
  4. Maciel J, Cavaco D, Silvestre C, Simões Pereira J, Vilar H, Leite V. Clinical outcomes of a cohort of 271 patients with lung metastases from differentiated thyroid carcinoma. Clinical Endocrinology. 2022; 97(6): 814-21.
  5. Cho SW, Choi HS, Yeom GJ, Lim JA, Moon JH, Park DJ, et al. Long-term prognosis of differentiated thyroid cancer with lung metastasis in Korea and its prognostic factors. Thyroid. 2014; 24(2): 277-86.
  6. Song HJ, Qiu ZL, Shen CT, Wei WJ, Luo QY. Pulmonary metastases in differentiated thyroid cancer: efficacy of radioiodine therapy and prognostic factors. European Journal of Endocrinology. 2015; 173(3): 399-408.
  7. Freudenberg LS, Jentzen W, Müller SP, Bockisch A. Disseminated iodine-avid lung metastases in differentiated thyroid cancer: a challenge to 124I PET. European Journal of Nuclear Medicine and Molecular Imaging. 2008; 35(3):502-8.
  8. Kalshetty A, Basu S. Assessment of pulmonary metastasis in differentiated thyroid carcinoma: value of HRCT correlation with functional imaging. World Journal of Nuclear Medicine. 2023; 22(02): 087-99.
  9. Basu S, Kalshetty A. Volumetric high-resolution computed tomography in evaluating pulmonary metastases from differentiated thyroid carcinoma: considerations for evolving the optimal diagnostic pathway. Nuclear Medicine Communications. 2017; 38(10): 881-2.
  10. Hassan FU, Mohan HK. Clinical utility of SPECT/CT imaging post-radioiodine therapy: does it enhance patient management in thyroid cancer? European Thyroid Journal. 2015; 4(4): 239-45.
  11. Ronga G, Filesi M, Montesano T, Di Nicola A, Pace C, Travascio L, et al. Lung metastases from differentiated thyroid carcinoma. Quarterly Journal of Nuclear Medicine and Molecular Imaging. 2004; 48:12-9.
  12. Lin JD, Hsueh C, Chao TC. Long-term follow-up of the therapeutic outcomes for papillary thyroid carcinoma with distant metastasis. Medicine. 2015; 94(26): e1063.
  13. Yang J, Liang M, Jia Y, Wang L, Lin L, Geng J, et al. Therapeutic response and long-term outcome of differentiated thyroid cancer with pulmonary metastases treated by radioiodine therapy. Oncotarget. 2017; 8(54): 92715.
  14. Wu S, Wang H. Efficacy analysis of (131)I therapy and predictive value of preablation stimulated thyroglobulin for lung metastases from differentiated thyroid cancer. Ann Endocrinol (Paris). 2013; 74(1): 40-4.
  15. Wang R, Zhang Y, Tan J, Zhang G, Zhang R, Zheng W, et al. Analysis of radioiodine therapy and prognostic factors of differentiated thyroid cancer patients with pulmonary metastasis: an 8-year retrospective Medicine. 2017; 96(19): e6809.
  16. Bhagat JK, Prasad BD. Radioiodine Therapy for Differentiated Thyroid Carcinoma: Inhs Asvini Experience. Medical Journal Armed Forces India. 1998; 54(1): 38-40.
  17. Okamoto S, Shiga T, Uchiyama Y, Manabe O, Kobayashi K, Yoshinaga K, et al. Lung uptake on I-131 therapy and short-term outcome in patients with lung metastasis from differentiated thyroid cancer. Annals of Nuclear Medicine. 2014; 28(2):81-7.
  18. Tallini G, de Biase D, Repaci A, Visani M. What’s new in thyroid tumor classification, the 2017 World Health Organization classification of tumours of endocrine organs. In: Kakudo, K. (eds) Thyroid FNA cytology. Springer, Singapore. 2019:37-47.
  19. Kalshetty A, Basu S. Assessment of pulmonary metastasis in differentiated thyroid carcinoma: value of HRCT correlation with functional imaging. World Journal of Nuclear Medicine. 2023; 22(02): 087-99.
  20. Song HJ, Qiu ZL, Shen CT, Wei WJ, Luo QY. Pulmonary metastases in differentiated thyroid cancer: efficacy of radioiodine therapy and prognostic factors. European Journal of Endocrinology. 2015; 173(3): 399-408.
  21. Akatani N, Wakabayashi H, Kayano D, Inaki A, Takata A, Hiromasa T, et al. Long-term outcomes and prognostic factors of patients with lung metastases from differentiated thyroid cancer after radioiodine therapy in Endocrine Journal. 2023; 70(3): 315-22.
  22. Shoup M, Stojadinovic A, Nissan A, Ghossein RA, Freedman S, Brennan MF, et al. Prognostic indicators of outcomes in patients with distant metastases from differentiated thyroid carcinoma. Journal of the American College of Surgeons. 2003; 197(2): 191-7.
  23. Park HJ, Jeong GC, Kwon SY, Min JJ, Bom HS, Park KS, et al. Stimulated serum thyroglobulin level at the time of first dose of radioactive iodine therapy is the most predictive factor for therapeutic failure in patients with papillary thyroid carcinoma. Nuclear Medicine and Molecular Imaging. 2014; 48(4): 255-61.
  24. Lee JY, Baek JH, Ha EJ, Sung JY, Shin JH, Kim JH, et al. 2020 Imaging guidelines for thyroid nodules and differentiated thyroid cancer: Korean Society of Thyroid Radiology. Korean journal of radiology. 2021; 22(5): 840-860.
  25. Schwartz LH, Litière S, De Vries E, Ford R, Gwyther S, Mandrekar S, et al. RECIST 1.1-Update and clarification: From the RECIST committee. European Journal of Cancer. 2016; 62: 132-7.
  26. He L, Teng Y, Jin B, Zhao M, Yu P, Hu X, et al. Initial partial response and stable disease according to RECIST indicate similar survival for chemotherapeutical patients with advanced non-small cell lung cancer. BMC Cancer. 2010; 10(1): 681.
  27. Klain M, Zampella E, Piscopo L, Volpe F, Manganelli M, Masone S, et al. Long-term prognostic value of the response to therapy assessed by laboratory and imaging findings in patients with differentiated thyroid cancer. Cancers .2021; 13 (17): 4338.
  28. Sohn SY, Kim HI, Kim YN, Kim TH, Kim SW, Chung JH. Prognostic indicators of outcomes in patients with lung metastases from differentiated thyroid carcinoma during long‐term follow‐up. Clinical Endocrinology. 2018; 88(2): 318-26.
  29. Kim M, Kim WG, Park S, Kwon H, Jeon MJ, Lee JJ, et al. Initial size of metastatic lesions is best prognostic factor in patients with metastatic differentiated thyroid carcinoma confined to the lung. Thyroid. 2017; 27(1): 49-58.
  30. Liu W, Wang S, Ye Z, Xu P, Xia X, Guo M. Prediction of lung metastases in thyroid cancer using machine learning based on SEER database. Cancer Medicine. 2022; 11(12): 2503-15.
  31. Kwon SY, Lee SW, Kong EJ, Kim K, Kim BI, Kim J, et al. Clinicopathologic risk factors of radioactive iodine therapy based on response assessment in patients with differentiated thyroid cancer: a multicenter retrospective cohort study. European Journal of Nuclear Medicine and Molecular Imaging. 2020; 47(3): 561-571.
  32. Freudenberg LS, Jentzen W, Müller SP, Bockisch A. Disseminated iodine-avid lung metastases in differentiated thyroid cancer: a challenge to 124I PET. European Journal of Nuclear Medicine and Molecular Imaging. 2008; 35(3): 502-8.
  33. Avram AM, Zukotynski K, Nadel HR, Giovanella L. Management of differentiated thyroid cancer: the standard of care. Journal of Nuclear Medicine. 2022; 63(2): 189-95.
Asia Oceania Journal of Nuclear Medicine and Biology
Volume 14, Issue 1
January 2026
Pages 54-66