Pre-Therapeutic Measurements of Iodine Avidity in Papillary and Poorly Differentiated Thyroid Cancer Reveal Associations with Thyroglobulin Expression, Histological Variants and Ki-67 Index

Simple Summary In the treatment of thyroid cancer, tumour uptake of iodine is important because it enables the use of radioactive iodine to kill cancer tissue. How radioactive iodine treatments are performed is usually determined by the size of the tumour. This study attempted to find new ways of predicting iodine uptake in advance of treatment. Several factors were found to predict uptake better than tumour size, all relatively simple to investigate in routine healthcare. This information can potentially be used to treat thyroid cancer patients more in accordance with how their tumours behave. Papillary thyroid cancer (PTC) and poorly differentiated thyroid cancer (PDTC) are treated with radioiodine to reduce recurrence and to treat the spread of disease. Adequate iodine accumulation in cancer tissue, iodine avidity, is important for treatment effect. This study investigated which clinical and histological tumour characteristics correlate with avidity. To quantify avidity in cancer tissue, tracer amounts of iodine-131 were given to 45 patients with cytologically confirmed thyroid cancer. At pathology grossing, representative samples of tumour and lymph nodes were taken and subjected to radioactivity quantification ex vivo to determine avidity. Afterwards, samples underwent extended pathology work-up and analysis. We found that tumoural Tg expression and Ki-67 index were correlated with avidity, whereas tumour size and pT stage were not. The histological variant of thyroid cancer was also correlated with iodine avidity. Variants associated with worse clinical prognoses displayed lower avidity than variants with better prognoses. This work provides new information on which tumours have low iodine avidity. Lower avidity in aggressive histological PTC variants may explain their overall poorer prognoses. Our findings also suggest that radioiodine dosage could be adapted to Tg expression, Ki-67 index or histological variant instead of pT stage, potentially improving the efficacy of radioiodine therapy.

Automated summary

This study investigated the correlation between iodine avidity in cancer tissue and clinical and histological tumor characteristics. Tumor Tg expression, Ki-67 index, and histological variant were found to be correlated with avidity, whereas tumor size and pT stage were not. Variants associated with worse clinical prognoses displayed lower avidity, suggesting that radioiodine dosage could be adapted to these factors instead of pT stage to improve efficacy of therapy.