Management of thyroid nodules incidentally discovered on MIBI scanning for primary hyperparathyroidism

Greilsamer, Tristan; Blanchard, Claire; Christou, Niki; Drui, Delphine; Ansquer, C.; Bras, M. Le; Cariou, Bertrand; Caillard, C.; Mourrain-Langlois, E.; Delemazure, Anne Sophie; Mathonnet, Muriel; Kraeber-Bodéré, Françoise; Mirallié, Éric

doi:10.1007/s00423-015-1286-y

Cited by 15 publications

(8 citation statements)

References 26 publications

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“…In this study, 64.0% of patients had at least one thyroid nodule in preoperative US. While this rate is higher than in previous studies [35], in endemic goitre regions, the rate of PHPT with thyroid nodules ranges between 15 and 84% [2][3][4][5][6]. Therefore, preoperative US is so important in patients with PHPT [2,3].…”

Section: Preoperative Imaging With Ultrasoundmentioning

confidence: 68%

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Accessing the influence of 99mTc-Sesta-MIBI-positive thyroid nodules on preoperative localisation studies in patients with primary hyperparathyroidism

Hargitai

Schefner

Traub‐Weidinger

et al. 2022

Langenbecks Arch Surg

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Purpose Curative treatment for primary hyperparathyroidism (PHPT) is parathyroidectomy (PTX) with removal of the hyperfunctioning gland(s). In an endemic goitre region, 35–78% of PHPT patients show concomitant thyroid disease. This study aimed to evaluate if 99mTc-sestamibi (MIBI)-positive thyroid nodules decrease sensitivity in regard to localising the hyperfunctioning parathyroid gland(s) in PHPT patients. Methods Within 5 years, 497 consecutive patients with biochemically proven PHPT were included in this study. The data was analysed retrospectively. Results In total, 198 patients underwent PTX with thyroid surgery and 299 patients underwent sole PTX. Sensitivity of MIBI scan for PTX with and without thyroid surgery was 72.1% and 73.6%, respectively. A statistically significant difference in sensitivity of ultrasound for PTX with and without thyroid surgery (57.0% and 70.9%, respectively) was observed (p = 0.029). Thyroid nodule histology did not have a significant effect on the MIBI scan. Unilateral neck exploration (UNE) was performed in 110 patients and bilateral neck exploration (BNE) in 177 patients. The probability of surgical conversion from UNE to BNE due to incorrect localisation was 1.733 times higher in patients with thyroid nodules. Conclusions Concomitant benign thyroid nodules did not influence MIBI sensitivity. No correlation between thyroid carcinoma and MIBI uptake was determined. However, MIBI detection of thyroid malignancy is important in patients initially being considered for minimal invasive parathyroidectomy. Sensitivity and positive predictive value of ultrasound were significantly lower in patients with thyroid nodules. The probability of conversion from UNE to BNE due to incorrect localisation was 1.733 times higher in patients with thyroid nodules.

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Section: Preoperative Imaging With Ultrasoundmentioning

confidence: 68%

“…The only curative option is parathyroidectomy (PTX) [1]. In the literature, 15-84% of PHPT patients in endemic goitre regions have additional thyroid disease [2][3][4][5][6]. Interestingly, in 2-24% of patients with PHPT, thyroid carcinoma is diagnosed [7].…”

Section: Introductionmentioning

confidence: 99%

Accessing the influence of 99mTc-Sesta-MIBI-positive thyroid nodules on preoperative localisation studies in patients with primary hyperparathyroidism

Hargitai

Schefner

Traub‐Weidinger

et al. 2022

Langenbecks Arch Surg

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“…This is still true, since the spatial resolution of the pinhole collimator cannot be reached with any parallel-hole collimator. The highest achievable resolution is important especially for detecting the thyroid nodules, especially the sestamibi-hot/iodine-cold phenotype which may indicate thyroid malignancy [ 19 , 20 ]. This phenotype also results in false-positive residual activity in subtraction images, which can be easily interpreted as parathyroid adenoma.…”

Section: Discussionmentioning

confidence: 99%

^99mTc-Sestamibi/¹²³I Subtraction SPECT/CT in Parathyroid Scintigraphy: Is Additional Pinhole Imaging Useful?

Tunninen

Varjo

Kauppinen

et al. 2017

International Journal of Molecular Imaging

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Objectives This retrospective study evaluated whether the use of additional anterior 99mTc-sestamibi/123I pinhole imaging improves the outcome of 99mTc-sestamibi/123I subtraction SPECT/CT in parathyroid scintigraphy (PS). Materials and Methods PS using simultaneous dual-isotope subtraction methods and an acquisition protocol combining SPECT/CT and planar pinhole imaging was performed for 175 patients with primary or secondary hyperparathyroidism. All patients who proceeded to surgery with complete postsurgery laboratory findings were included in this study (n = 94). SPECT/CT images alone and combined with pinhole images were evaluated. Results There were 111 enlarged parathyroid glands of which 104 and 108 glands were correctly visualized by SPECT/CT (seven false positives) or SPECT/CT with pinhole (three false positives), respectively. Both sensitivity and specificity were higher with combined SPECT/CT with pinhole than with SPECT/CT alone (97% versus 94% and 99% versus 98%, resp., not significant). The false-positive rate was 6% with SPECT/CT and decreased to 3% using combined SPECT/CT with pinhole. Conclusion 99mTc-sestamibi/123I subtraction SPECT/CT is a highly sensitive and specific protocol for PS. The use of additional anterior pinhole imaging increases both sensitivity and specificity of PS, although this increase is not statistically significant.

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“…The total incidence of papillary thyroid malignancy in our study population was 7.14%, which is comparable to the literature. 21,22,25…”

Section: Discussionmentioning

confidence: 99%

The Incidental Thyroid Lesion in Parathyroid Disease Management

et al. 2017

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ObjectiveThe incidental thyroid lesion is a common finding during general imaging studies. Their management has been the subject of numerous studies and recommendations. Parathyroid disease workup necessitates imaging investigation of the adjacent thyroid gland and therefore provides a unique window to the perioperative management of thyroid incidentaloma. The specific prevalence of incidental thyroid lesions in the context of parathyroid disease is unknown. We seek to investigate its prevalence during parathyroid workup and surgery and to ascertain if there was a change in management of these patients.Study DesignFive-year retrospective database review.SettingTertiary care medical center.Subjects and MethodsThe source and indication for referral, preoperative investigation findings, and management of the incidental thyroid lesions were examined. The actual procedure performed and final pathology results were assessed.ResultsA total of 98 patients and 106 operations, including revision surgeries, were identified. There were 21 incidental thyroid lesions (21.4%) detected, whereby 15 patients underwent fine-needle aspirations and 12 subsequently had diagnostic hemithyroidectomies. This decision was made preoperatively in 5 patients and intraoperatively in 7 patients at the time of parathyroid surgery. Along with other pathologies, there were 7 patients with micropapillary thyroid carcinoma identified.ConclusionsIn our series, the prevalence of incidental thyroid lesion and thyroid malignancy is comparable to the general population. The management of the initial parathyroid disease in our patients was altered by the imaging and cytological findings of these thyroid lesions. This has implications on perioperative counseling of the thyroid and parathyroid disease.

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Management of thyroid nodules incidentally discovered on MIBI scanning for primary hyperparathyroidism

Abstract: Thyroid nodules incidentally discovered on MIBI in hyperparathyroidism patients should be resected.

Cited by 15 publications

References 26 publications

Accessing the influence of 99mTc-Sesta-MIBI-positive thyroid nodules on preoperative localisation studies in patients with primary hyperparathyroidism

Accessing the influence of 99mTc-Sesta-MIBI-positive thyroid nodules on preoperative localisation studies in patients with primary hyperparathyroidism

^99mTc-Sestamibi/¹²³I Subtraction SPECT/CT in Parathyroid Scintigraphy: Is Additional Pinhole Imaging Useful?

The Incidental Thyroid Lesion in Parathyroid Disease Management

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Management of thyroid nodules incidentally discovered on MIBI scanning for primary hyperparathyroidism

Abstract: Thyroid nodules incidentally discovered on MIBI in hyperparathyroidism patients should be resected.

Cited by 15 publications

References 26 publications

Accessing the influence of 99mTc-Sesta-MIBI-positive thyroid nodules on preoperative localisation studies in patients with primary hyperparathyroidism

Accessing the influence of 99mTc-Sesta-MIBI-positive thyroid nodules on preoperative localisation studies in patients with primary hyperparathyroidism

99mTc-Sestamibi/123I Subtraction SPECT/CT in Parathyroid Scintigraphy: Is Additional Pinhole Imaging Useful?

The Incidental Thyroid Lesion in Parathyroid Disease Management

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^99mTc-Sestamibi/¹²³I Subtraction SPECT/CT in Parathyroid Scintigraphy: Is Additional Pinhole Imaging Useful?