Combined use of fine-needle aspiration biopsy, MIBI scans and frozen section biopsy offers the best diagnostic accuracy in the assessment of the hypofunctioning solitary thyroid nodule

Hurtado-López, Luis Mauricio; Arellano-Montaño, Sara; Torres-Acosta, Evelyn Migdalia; Zaldivar‐Ramírez, Felipe Rafael; Duarte-Torres, Reyna Margarita; Alonso-de-Ruiz, Patricia; Martínez-Duncker, Iván; Martínez‐Duncker, Carlos

doi:10.1007/s00259-004-1544-7

Cited by 62 publications

(65 citation statements)

References 36 publications

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“…Particularly, differentiated thyroid carcinoma has been reported to intensively accumulate and persistently retain 99m Tc-MIBI (18)(19)(20)(21)(22)(23)(24). However, discrepant results have been reported about the usefulness of 99m Tc-MIBI scanning in identifying thyroid carcinoma, especially in mitochondria-rich oncocytic lesions (22,(25)(26)(27).…”

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confidence: 85%

“…Several authors have expressed the possibility that 99m Tc-MIBI scintigraphy is a reliable adjunctive procedure for improving the diagnostic accuracy of thyroid fineneedle aspiration cytology (18)(19)(20)(21)(22)(23)(24). However, the overall published data on effectiveness in differentiating thyroid cancer from benign lesions are inconclusive, mostly because of low specificity (18).…”

Section: Multidrug Resistance Protein Expressionmentioning

confidence: 95%

“…To this purpose, some investigators have proposed thyroid 99m Tc-methoxyisobutylisonitrile ( 99m Tc-MIBI) scintiscanning in an attempt to differentiate benign from malignant thyroid nodules (18)(19)(20)(21)(22)(23)(24). Particularly, differentiated thyroid carcinoma has been reported to intensively accumulate and persistently retain 99m Tc-MIBI (18)(19)(20)(21)(22)(23)(24).…”

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confidence: 99%

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^99mTc-MIBI Imaging in the Presurgical Characterization of Thyroid Follicular Neoplasms: Relationship to Multidrug Resistance Protein Expression

Saggiorato¹,

Angusti²,

Rosas³

et al. 2009

J Nucl Med

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Recently, thyroid 99m Tc-methoxyisobutylisonitrile ( 99m Tc-MIBI) scintiscanning has been proposed in an attempt to preoperatively identify thyroid malignancies, but discrepant results have been reported for oncocytic lesions. The aim of this study was to investigate the usefulness of visual and semiquantitative analyses of 99m Tc-MIBI scintigraphy for preoperatively characterizing thyroid nodules with indeterminate cytologic diagnoses, segregating in advance nononcocytic variants from those that are oncocytic. This study also aimed to analyze the relationship between 99m Tc-MIBI images and P-glycoprotein (P-gp)/multidrug resistance-associated protein-1 (MRP1) immunohistochemical expression. Methods: Fifty-one consecutive patients with cold thyroid nodules cytologically diagnosed as nononcocytic or oncocytic follicular neoplasm were prospectively studied. Visual and semiquantitative 99m Tc-MIBI scanning was performed and the diagnoses of the lesions were histologically proven by subsequent thyroidectomy. Immunohistochemical evaluation of P-gp and MRP1 was also performed on surgical samples. Results: Visual and semiquantitative 99m Tc-MIBI scintiscans showed a low specificity in preoperatively discriminating malignant oncocytic lesions. In nononcocytic nodules, the semiquantitative method was more accurate than the visual (94.44% and 77.78%, respectively). P-gp protein expression was negative in all thyroid lesions, whereas apical plasma membrane MRP1 expression was found in 78% of the lesions with a negative 99m Tc-MIBI retention index, compared with 11% of lesions with a positive retention index, correlating most strongly with a negative 99m Tc-MIBI RI in those cases with strong MRP1 apical expression. Conclusion: Semiquantitative 99m Tc-MIBI scintigraphy is an adjunctive method to predict preoperatively the malignant behavior of nononcocytic follicular thyroid nodules indeterminate at fine-needle aspiration biopsy, with a potential impact on the definition of their clinical management. Moreover, the good correlation found between immunohistochemical apical expression of MRP1 and the scintigraphic findings supports the 99m Tc-MIBI results and provides tissue information on the molecular mechanisms responsible for 99m Tc-MIBI images in thyroid lesions.

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confidence: 85%

Section: Multidrug Resistance Protein Expressionmentioning

confidence: 95%

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confidence: 99%

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^99mTc-MIBI Imaging in the Presurgical Characterization of Thyroid Follicular Neoplasms: Relationship to Multidrug Resistance Protein Expression

Saggiorato¹,

Angusti²,

Rosas³

et al. 2009

J Nucl Med

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“…MIBI was first described in the 1980s [1,2]. Originally developed for myocardial perfusion scintigraphy for the detection and localization of coronary artery disease, it went on to eventually achieve registration not only for this indication, but also for the assessment of global ventricular function, scintimammography for the detection of suspected breast cancer when mammography is equivocal, inadequate or indeterminate, and localization of hyperfunctioning parathyroid tissue in patients with recurrent or persistent hyperparathyroidism, both primary and secondary, and in patients with primary hyperparathyroidism scheduled to undergo initial surgery of the parathyroid glands [3].However, for many years it has been known that MIBI scintigraphy can also be used in the diagnostic work-up of scintigraphically cold and therefore suspicious thyroid nodules in combination with fine needle biopsy (FNB) [4][5][6][7][8][9][10][11][12] Tc-pertechnetate thyroid scintigraphy MIBI scintigraphy can achieve a very high negative predictive value ranging from 88 % to 100 % with a mean of 97 %. Furthermore, the sensitivity of MIBI scintigraphy is similarly good with an aggregate value of 96 %.…”

mentioning

confidence: 99%

“…However, for many years it has been known that MIBI scintigraphy can also be used in the diagnostic work-up of scintigraphically cold and therefore suspicious thyroid nodules in combination with fine needle biopsy (FNB) [4][5][6][7][8][9][10][11][12] Tc-pertechnetate thyroid scintigraphy MIBI scintigraphy can achieve a very high negative predictive value ranging from 88 % to 100 % with a mean of 97 %. Furthermore, the sensitivity of MIBI scintigraphy is similarly good with an aggregate value of 96 %.…”

mentioning

confidence: 99%

Cost-effectiveness of 99mTc-MIBI in the evaluation of thyroid nodules for malignancy: a new lease of life for an old radiopharmaceutical?

Verburg

Behrendt

Mottaghy

et al. 2013

Eur J Nucl Med Mol Imaging

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In nuclear medicine practice, physicians are often confronted with the problem that formal registration of a specific radiopharmaceutical and the indications for its use are lacking (e.g. the modern 68 Ga-labelled somatostatin analogues). If formal registration is available, this registration often only covers a few, specific and predominantly commercially interesting indications even when the radiopharmaceutical can be applied more broadly. A good example of the latter is the case of 99m Tc-methoxyisobutylisonitrile (MIBI). MIBI was first described in the 1980s [1,2]. Originally developed for myocardial perfusion scintigraphy for the detection and localization of coronary artery disease, it went on to eventually achieve registration not only for this indication, but also for the assessment of global ventricular function, scintimammography for the detection of suspected breast cancer when mammography is equivocal, inadequate or indeterminate, and localization of hyperfunctioning parathyroid tissue in patients with recurrent or persistent hyperparathyroidism, both primary and secondary, and in patients with primary hyperparathyroidism scheduled to undergo initial surgery of the parathyroid glands [3].However, for many years it has been known that MIBI scintigraphy can also be used in the diagnostic work-up of scintigraphically cold and therefore suspicious thyroid nodules in combination with fine needle biopsy (FNB) [4][5][6][7][8][9][10][11][12] Tc-pertechnetate thyroid scintigraphy MIBI scintigraphy can achieve a very high negative predictive value ranging from 88 % to 100 % with a mean of 97 %. Furthermore, the sensitivity of MIBI scintigraphy is similarly good with an aggregate value of 96 %. This indicates that a negative MIBI scan will obviate the need to surgically remove the thyroid nodule for definitive histological clarification in the large majority of patients, as the risk of malignancy in such a nodule is very low.This of course does have economic implications. Considering that the risk of missing the diagnosis of thyroid cancer is low, and a large number of, in hindsight unnecessary, comparatively expensive surgical procedures can be avoided, it is not surprising that Wale et al. are able to show that the addition of MIBI scintigraphy leads to a considerable saving in costs per patient and per cancer diagnosed while not significantly affecting life expectancy [13].Of course, the model used by Wale et al. is a theoretical one and any model requires simplification of the sometimes complex individual situations of different patients. For example, the authors did not directly assess the life expectancy of patients scanned with MIBI, but derived these data from unrelated survival analyses of patients with thyroid cancer. This and further notable limitations of the model are mainly due to the lack of data from prospective randomized controlled trials.

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Reporting thyroid fine-needle aspiration: Literature review and a proposal

Wang

2005

Diagn. Cytopathol.

114

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Reporting schemes for thyroid fine-needle aspirations in the literature were reviewed and classified according to the number of categories in the scheme and the significance of each category. The sensitivity, specificity, and positive predictive and negative values were determined for each scheme, if possible. A reporting scheme based on the probability of finding carcinoma on histology is proposed.

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Combined use of fine-needle aspiration biopsy, MIBI scans and frozen section biopsy offers the best diagnostic accuracy in the assessment of the hypofunctioning solitary thyroid nodule

Cited by 62 publications

References 36 publications

^99mTc-MIBI Imaging in the Presurgical Characterization of Thyroid Follicular Neoplasms: Relationship to Multidrug Resistance Protein Expression

^99mTc-MIBI Imaging in the Presurgical Characterization of Thyroid Follicular Neoplasms: Relationship to Multidrug Resistance Protein Expression

Cost-effectiveness of 99mTc-MIBI in the evaluation of thyroid nodules for malignancy: a new lease of life for an old radiopharmaceutical?

Reporting thyroid fine-needle aspiration: Literature review and a proposal

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