EP78 – The impact of dual-isotope parathyroid scintigraphy in thyroid cancer detection


    Koutsikos, Ioannis1; Velidaki, Antigoni2
    1 Department of Nuclear Medicine,  Army Share Fund Hospital, Athens, Greece
    2 Department of Nuclear Medicine, Laiko General Hospital of Athens, Athens, Greece


    Background/ Purpose: Parathyroid scintigraphy with Tc-99m Sestamibi (MIBI) is recommended in patients with primary hyperparathyroidism. Several protocols are currently in use. Subtraction planar scintigraphy with dual-isotope, seems to be more accurate and reliable; however, methods with single isotope and with early and delayed images are also in use. MIBI has been reported as highly sensitive for thyroid neoplasia; however, it is not currently performed for routine clinical application. The aim of our study was to determine, in the same patients with primary hyperparathyroidism, the impact of MIBI–Tc-99m pertechnetate scintigraphy in identifying thyroid cancer.

    Methods: We studied prospectively the database of 485 patients who underwent parathyroid scintigraphy in our departments. We identified patients who were operated for PHPT and underwent simultaneous thyroidectomy.

    Results: A total of 80 patients underwent both thyroidectomy and parathyroidectomy. Papillary carcinoma was detected in 2 patients (2.5%), both with multifocal tumors. MIBI early-delayed imaging was positive in 62 patients; in 18 patients no area of increased MIBI uptake was revealed. On Tc-99m pertechnetate scintigraphy, 8/62 MIBI (+)ve patients had also increased radiopharmaceutical uptake, while 4 patients had “cold” nodules; 2 in accordance with MIBI (+)ve site and in 2/18 MIBI (-)ve patients. The 2 MIBI (+)ve/ Tc-99m pertechnetate cold were the patients with the papillary carcinoma. In the 2 MIBI (-)ve/ Tc-99m pertechnetate cold patients, neither malignancy, nor parathyroid abnormality was identified.

    Discussion & Conclusion: The dual-isotope parathyroid scintigraphy is superior to other scintigraphic techniques in detecting thyroid cancer. We should be aware of a MIBI (+)ve/ Tc-99m pertechnetate cold pattern.



    1. Emirikçi S, Özç?nar B, Öner G, Omarov N, A?cao?lu O, Soyta? Y, et al. Thyroid cancer incidence in simultaneous thyroidectomy with parathyroid surgery. Ulus Cerrahi Derg. 2015 Aug 18;31(4):214-7.
    2. Onkendi EO, Richards ML, Thompson GB, Farley DR, Peller PJ, Grant CS. Thyroid cancer detection with dual-isotope parathyroid scintigraphy in primary hyperparathyroidism. Ann Surg Oncol. 2012 May;19(5):1446-52.
    3. Riazi A, Kalantarhormozi M, Nabipour I, Eghbali SS, Farzaneh M, Javadi H, et al. Technetium-99m methoxyisobutylisonitrile scintigraphy in the assessment of cold thyroid nodules: is it time to change the approach to the management of cold thyroid nodules? Nucl Med Commun. 2014 Jan;35(1):51-7.
    4. Rubello D, Toniato A, Pelizzo MR, Casara D. Papillary thyroid carcinoma associated with parathyroid adenoma detected by pertechnetate-MIBI subtraction scintigraphy. Clin Nucl Med. 2000 Nov;25(11):898-900.
    5. Ryhänen EM, Schildt J, Heiskanen I, Väisänen M, Ahonen A, Löyttyniemi E, et al. (99m)Technetium Sestamibi-(123)Iodine Scintigraphy Is More Accurate Than (99m)Technetium Sestamibi Alone before Surgery for Primary Hyperparathyroidism. Int J Mol Imaging. 2015;2015:391625.
    6. Wale A, Miles KA, Young B, Zammit C, Williams A, Quin J, et al. Combined (99m)Tc-methoxyisobutylisonitrile scintigraphy and fine-needle aspiration cytology offers an accurate and potentially cost-effective investigative strategy for the assessment of solitary or dominant thyroid nodules. Eur J Nucl Med Mol Imaging. 2014 Jan;41(1):105-15.


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