Preoperative scintigraphic visualization of lymph nodes and pulmonary metastases from papillary thyroid carcinoma

Abstract

Preoperative accumulation of Tc-99m pertechnetate and radioiodine in metastases of well-differentiated thyroid carcinoma is uncommon. We report herein the case of a 39-year-old woman with occult papillary thyroid cancer revealed by widespread miliary lung metastases. Ultrasonography revealed the presence of an infracentimetric hypoechoic nodule and cervical lymph nodes. Scintigraphy, realized with Tc-99m pertechnetate and I-131 prior to thyroidectomy, failed to delineate the primary thyroid tumor, but revealed functional cervical nodes on the central and left lateral compartments, with pulmonary accumulation.

Thyroid Imaging in the Dog: Current Status and Future Directions

“…26,41 For the detection of thyroid carcinoma metastasis in people, radioiodine is more sensitive than pertechnetate. 40,42 Conflicting results, however, are reported. 40 The use of tracers such as 99m Tc-sestamibi, 201 Tl, and 99m Tc-tetrofosmin or the use of single-photon emission tomography (SPECT) instead of planar imaging could increase the sensitivity of scintigraphy in the detection of metastases (Fig 7).…”

“…10,26,27 However, false negatives occur until a total or near total thyroidectomy (including remaining normal thyroid tissue) is performed because an unfavorable tracer competition exists between normal tissue and distant metastases. 10,26,27,40 For this reason, thyroid scintigraphy is considered a relatively specific tool for identification of metastasis, but is not considered sensitive. 2,3 Scintigraphic visualization of metastases in the presence of intact thyroid tissue indicates a high trapping ability of iodine in the tumor tissue and, therefore, may be considered as a predictive factor of radioiodine therapy effectiveness.…”

“…2,3 Scintigraphic visualization of metastases in the presence of intact thyroid tissue indicates a high trapping ability of iodine in the tumor tissue and, therefore, may be considered as a predictive factor of radioiodine therapy effectiveness. 3,40 Nonthyroidal masses, esophageal activity from swallowed saliva, breast tissue, thymus, and skin contamination also may cause abnormal focal pertechnetate accumulations, resulting in false positive results. 26,41 For the detection of thyroid carcinoma metastasis in people, radioiodine is more sensitive than pertechnetate.…”

Thyroid cancer diagnosed by a routine scan

“…Therefore, radio isotopic detection of lymph node metastases secondary to thyroid cancer, in the presence of thyroid, is rare [1,2] CliNiCAl imAgES PEER REviEwEd | OPEN ACCESS Among the different subtypes of follicular variant of PTC the DFVPTC is also rare, is considered to be more common in young females and has been associated with an aggressive behavior [3]. Contrasting with previous reports, the case presented herein had a favorable outcome.…”

“…Although rare [1,2], the observation of abnormal bilateral uptake, outside of the thyroid bed, in a patient with thyroid ( Figure 1; Panel A), was consistent with uptake by metastatic lymph nodes from a thyroid cancer. An ultrasound guided cytology was positive for papillary thyroid cancer (PTC).…”