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.

     

    References:

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