Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2021; 9(1): 71-80
Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.71
Primary lung cancer with radioiodine avidity: A thyroid cancer cohort study
Yu-Ling Lu, Szu-Tah Chen, Tsung-Ying Ho, Wen-Hui Chan, Richard J Wong, Chuen Hsueh, Shu-Fu Lin
Yu-Ling Lu, Shu-Fu Lin, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City 236, Taiwan
Yu-Ling Lu, Szu-Tah Chen, Shu-Fu Lin, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
Szu-Tah Chen, Shu-Fu Lin, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
Tsung-Ying Ho, Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
Wen-Hui Chan, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
Wen-Hui Chan, Institute for Radiological Research, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
Richard J Wong, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, United States
Chuen Hsueh, Department of Pathology, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan
Author contributions: Lin SF designed the study; Hsueh C performed the immunohistochemical study; all authors analyzed and interpreted the data; Lu YL wrote the first draft of this manuscript; Chen ST, Ho TY, Chan WH, Wong RJ, Hsueh C and Lin SF reviewed and revised the manuscript.
Supported by Chang Gung Memorial Hospital, No. CMRPG3J0471; and US NIH/NCI Cancer Center Support Grant, No. P30 CA008748.
Institutional review board statement: The present study was approved by the Chang Gung Medical Foundation Institutional Review Board (No. 202000365B0) and was conducted in accordance with the ethical principles of the Helsinki Declaration.
Informed consent statement: Informed consent was waived by Chang Gung Medical Foundation Institutional Review Board.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
Data sharing statement: The authors confirm that the data supporting the findings of this study are available within the article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shu-Fu Lin, MD, Doctor, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, No. 2 Jingcheng Road, New Taipei City 236, Taiwan. mmg@cgmh.org.tw
Received: September 17, 2020
Peer-review started: September 17, 2020
First decision: October 18, 2020
Revised: October 30, 2020
Accepted: November 13, 2020
Article in press: November 13, 2020
Published online: January 6, 2021
Processing time: 105 Days and 20.9 Hours
Abstract
BACKGROUND

A proportion of lung cancers show sodium/iodide symporter (NIS) expression. Lung cancers with NIS expression may uptake radioiodine (RAI) and show RAI-avid lesions on RAI scan for differentiated thyroid cancer (DTC) surveillance.

AIM

To investigate the possibility of RAI uptake by lung cancer in a cohort with thyroid cancer.

METHODS

RAI-avid lung cancers were analyzed using a prospectively maintained database of patients with thyroid cancer who were registered at a medical center between December 1, 1976 and May 28, 2018. NIS expression in lung cancer was assessed using immunohistochemical staining.

RESULTS

Of the 5000 patients with thyroid cancer from the studied dataset, 4602 had DTC. During follow-up, 33 patients developed primary lung cancer. Of these patients, nine received an iodine-131 (131I) scan within 1 year before the diagnosis of lung cancer. One of these nine lung cancers was RAI-avid. NIS expression was evaluated, and three of the eight available lung cancers revealed NIS expression. The proportions of lung cancer cells with NIS expression were 60%, 15%, and 10%. The RAI-avid lung cancer had the highest level of expression (60%). The RAI-avid lung cancer had a spiculated border upon single-photon emission computed tomography/computed tomography, which led to an accurate diagnosis.

CONCLUSION

A proportion of lung cancer demonstrates NIS expression and is RAI-avid. Clinicians should be aware of this possibility in the interpretation of RAI scintigraphy.

Keywords: Lung cancer; Radioiodine; Thyroid cancer; Adenocarcinoma; Sodium/iodide symporter

Core Tip: A radioiodine (RAI) scan is usually performed to detect the existence of differentiated thyroid cancer (DTC). A proportion of lung cancers demonstrate sodium/iodide symporter (NIS) expression. Lung cancers with NIS expression may be able to uptake RAI and show RAI-avid lesions on RAI scan, leading to misinterpretation upon performing this test for DTC surveillance. Single-photon emission computed tomography/computed tomography provides morphologic characterization of the functional tumor, improving diagnostic accuracy over RAI scan.