99mTc-MIBI SPECT/CT Scintigraphy and Ultrasound of the Anterior Neck Region in Diagnosing Parathyroid Gland Pathology in Patients with Thyroid Nodules

Abstract

Parathyroid scintigraphy with 99m Tc-MIBI is an imaging technique used in nuclear medicine and performed in patients with suspected hyperparathyroidism (HPT). The objective of this study was to evaluate the role of this technique in patients who, along with suspected HPT, also have thyroid nodules. Retrospective analysis included a period of 8 years (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013). The study included 91 patients with clinical or laboratory suspected HPT. Pathologic changes in parathyroid glands were demonstrated in 47 (70%) of 67 patients with positive scintigraphy. Pathologic changes in parathyroid glands were not evident in the remaining 20 (30%) patients. Out of nine patients with negative scintigraphy results but with suspected enlargement of the parathyroid gland examined by ultrasound, eight (89%) patients did not show pathologic changes in the parathyroid gland, whereas one (11%) patient had evident changes. Eight (54%) of 15 patients with suspected scintigraphy had positive ultrasound findings, as well as fine needle aspiration cytology (FNAC) findings with parathyroid hormone (PTH) determination in the aspirate. Seven (46%) patients had negative FNAC findings and PTH in the aspirate. The study showed scintigraphy to have high sensitivity (98%) in detecting patients with pathologic changes in the parathyroid glands. In patients with suspected HPT, scintigraphy needs to be combined with FNAC and PTH determination in the aspirate due to its low specificity of 28%.

Does the Presence of Chronic Lymphocytic Thyroiditis Affect Diagnostic Value of Fine Needle Aspiration Biopsy in Bethesda Category III Nodules?

“…This situation was explained by the fact that cellular atypia developing due to HT suggested AUS-FLUS diagnosis for non-malignant nodules and negatively affected diagnostic value of FNAB 2 . It is possible to come across literature articles indicating that a group of diseases including HT may increase false positivity even in noninvasive diagnostic tools such as scintigraphy scan with technetium-99m (sestamibi) 29 . In the article by Ho et al, the rate of malignancy has been reported as 38.6% (135/350) even in patients who were urgently operated on because they were diagnosed with AUS-FLUS and had suspicious features 14 .…”

Dual-energy computed tomography is a superior diagnostic performance for locating parathyroid tumors

“…Third, DECT has a higher thyroid radioiodine exposure than US and MIBI. Overall, more studies are needed to explore the factors that may impact the localization accuracy of DECT, such as the fact that DECT localization failed in 3 (3/19) patients in our study who also had thyroid cancer [30].…”