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Parathyroid scintigraphy with 99mTc-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...
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... i.e. quantity and prevalence of thyroid nodules and nodule size. Based on the US and scintigraphy findings, US guided FNA biopsy was performed at the neck sites with enhanced radiopharmaceutical accumulation. However, localized areas without radiopharmaceutical accumulation were also aspirated if they presented as enlarged parathyroid gland (Fig. 3). Normal, healthy parathyroid glands cannot be visualized by US imaging 4 ...
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Citations
... 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]. ...
Purpose
To analyze the accuracy of three imaging methods for locating parathyroid tumors preoperatively in patients with primary hyperthyroidism (PHPT).
Methods
We retrospectively analyzed the accuracy of dual-energy computed tomography (DECT), cervical ultrasound (US), and 99m-technetium-labeled methoxyisobutylisonitrile single-photon emission computed tomography/computed tomography (99mTc-MIBI SPECT/CT) for the preoperative localization of abnormal parathyroid glands in 277 patients, who underwent parathyroidectomy from February 2017 to March 2023 in our department. We compared the diagnostic efficiency of the three imaging methods for localization of abnormal parathyroid glands, including those with single parathyroid adenomas or carcinomas, double adenomas (DAs), multiple gland hyperplasia disease (MGHD), and ectopic parathyroid tumors.
Results
A total of 283 pathological parathyroid glands were found in the 277 PHPT patients. The DECT sensitivity of 93.3% was superior to that of US at 92.2% and 99mTc-MIBI SPECT/CT at 75.6%. Ectopic locations were diagnosed by DECT in 12/13 (92.3%) patients by 99mTc-MIBI SPECT/CT in 11/13 (84.6%) patients and by US in 8/13 (61.5%) patients. The diagnostic efficiency was 98.59% for the combination of US and DECT, 97.17% for MIBI and DECT, and 95.76% for US and 99mTc-MIBI SPECT/CT. The diagnostic efficiency of the combination of all three methods for identifying pathological parathyroid glands was 99.29%.
Conclusion
DECT has a higher diagnostic accuracy rate than US and 99mTc-MIBI SPECT/CT for the preoperative localization of abnormal parathyroid glands, and it has advantages for the localization of ectopic parathyroid glands. DECT shows promise as a first-line preoperative localization imaging method for PHPT patients and may lead to significantly improved preoperative localization of pathological parathyroid glands when combined with US and 99mTc-MIBI SPECT/CT.
... 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 . ...
SUMMARY – This study aimed to determine the relationship between the presence of Hashimoto’s thyroiditis (HT) and malignancy rates with prognostic factors in thyroid nodules diagnosed as
Bethesda category III, and to examine the effect of HT on diagnostic value of fine-needle aspiration biopsy (FNAB). Demographic information, preoperative examination, and final pathological
evaluation of patients with Bethesda category III (AUS-FLUS) nodules who had been operated
on in our department over the last 6 years were analyzed. Statistical analyses were performed using
the Student’s t-test, Mann-Whitney U test and χ2
-test and logistic regression analysis using SPSS
version 22 software. The malignancy rate on final pathology of 159 patients was 24.5%. Malignancy
rates were found to be higher in patients with HT coexistence (30.7% vs. 21.5%, p=0.20). Poor
prognostic factors such as multifocality, number of metastatic lymph nodes (p=0.04), and extrathyroidal extension were more common in patients with cancer in the pathology specimen who were
in the non-HT group. It cannot be said that HT decreases diagnostic value of FNAB in lesions
diagnosed with AUS-FLUS. The lower incidence of poor prognostic factors in the HT group may
be attributed to cytotoxic cell dominance in tumor immunity
