Nabothian Cyst a Predominant Cause of False-Positive Iodine Uptake in Uterus

Isoda, Takuro; Baba, Shingo; Maruoka, Yasuhiro; Kitamura, Yoshihisa; Nishie, Akihiro; Sasaki, Masayuki; Honda, Hiroshi

doi:10.1097/rlu.0000000000000504

Cited by 13 publications

(4 citation statements)

References 21 publications

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“…The following sections illustrate with examples the physiologic and nonthyroid pathologic variants on radioiodine scintigrams (Table) (7,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30).…”

Section: Radioiodine Imaging Protocolmentioning

confidence: 99%

Pictorial Review of False-Positive Results on Radioiodine Scintigrams of Patients with Differentiated Thyroid Cancer

Chudgar¹,

Shah²

2017

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Radioiodine has served an important role in the diagnostic workup and treatment of patients with differentiated thyroid cancer for more than 6 decades. The interpretation of radioiodine scintigraphic studies should be performed in conjunction with a comprehensive history, histopathologic correlation, and pertinent laboratory values, as well as correlation with available anatomic images and the findings from physical examination. A thorough understanding of the physiology and biodistribution of radioiodine is critical when interpreting radioiodine scintigraphic studies to avoid misinterpretation of physiologic and nonthyroid pathologic variants as thyroid cancer metastases. Differentiating a false-positive finding from a true metastasis on pretherapy radioiodine scintigrams is important to determine the appropriate radioiodine treatment dose. The correct interpretation of posttherapy radioiodine scintigraphic studies is also important to determine if repeat radioiodine treatment will be necessary and for the future clinical and imaging followup of the patient. A variety of different factors, such as the presence of the sodium-iodide symporter and the passive diffusion or retention of radioiodine in normal and pathologic structures, can result in false-positive results on radioiodine scintigrams. Numerous false-positive findings have been reported in the literature and are further demonstrated with the increasing availability of single photon emission computed tomography (SPECT) integrated with computed tomography (CT) as true dual-modality imaging (SPECT/CT). SPECT/CT has been documented to be of incremental value in the accurate anatomic localization and characterization of radioiodine uptake as false-positive findings, particularly in cases with discordant findings of a low serum thyroglobulin level but positive findings on radioiodine whole-body planar scintigrams. The objectives of this review are to describe the physiology and biodistribution of radioiodine and to provide examples of false-positive results on radioiodine scintigrams, with clinical and anatomic correlation, in the following categories of radioiodine uptake: functional uptake secondary to sodium-iodide symporter expression, radioiodine retention, nonthyroid neoplasms, inflammatory or infectious uptake, contamination, and other causes. RSNA, 2017.

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Section: Radioiodine Imaging Protocolmentioning

confidence: 99%

Pictorial Review of False-Positive Results on Radioiodine Scintigrams of Patients with Differentiated Thyroid Cancer

Chudgar¹,

Shah²

2017

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“…In addition, false-positive uptake of iodine-131 in the uterus during whole body scans has been reported. [3][4][5][6][7][8][9] In practice, superficially located Nabothian cysts can be broken by the spatula during smear taking, the mucoid content may stick to the brush and be smeared onto slides in conventional cytology or dissolved in the preserving solution for LBC preparations. In LBC, mucus is rarely present, as it is removed by the preserving solutions and centrifugation prior to slide preparation.…”

Section: Discussionmentioning

confidence: 99%

“…Reported complications of Nabothian cysts are hematometra, abnormal uterine bleeding, especially in the case of giant cysts, obstruction of labor passage, and rectal compression. In addition, false‐positive uptake of iodine‐131 in the uterus during whole body scans has been reported . In practice, superficially located Nabothian cysts can be broken by the spatula during smear taking, the mucoid content may stick to the brush and be smeared onto slides in conventional cytology or dissolved in the preserving solution for LBC preparations.…”

Section: Discussionmentioning

confidence: 99%

Nabothian cyst content: A potential pitfall for the diagnosis of invasive cancer on Pap test cytology

Barrigón

Ziadi

Jacot-Guillarmod

et al. 2018

Diagnostic Cytopathology

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Funding informationThe authors have no affiliation and no personal relationships with any companies or products mentioned in this article Nabothian cysts are common, benign findings of the squamocolumnar junction of the adult cervix. These cysts are filled with mucus and can also contain proteinaceous material, neutrophils, or neutrophil debris. Nabothian cysts can be broken by the spatula during smear taking, may stick to the brush and be smeared onto slides in conventional cytology or dissolved in the preserving solution for liquid-based cytology (LBC) preparations. The granular content of Nabothian cysts may be mistaken for the tumor diathesis (TD) pattern associated with invasive carcinoma.In the case described, the patient presented a high-grade squamous intraepithelial lesion associated with granular material (Nabothian cyst content) that we considered erroneously on LBC to be TD-like material, thus, raising the suspicion of invasive carcinoma. To the best of our knowledge, this is the first report showing that Nabothian cyst content may present a potential pitfall in the diagnosis of invasive carcinoma on LBC. K E Y W O R D S cervical cancer, liquid-based cytology, Nabothian cyst, tumor diathesis 1 | INTRODUCTION Cervical cancer screening in Switzerland is performed on an opportunistic basis, primarily using cytology by conventional smears and/or liquid-based cytology (LBC). The employment of cytology as a screening tool is certainly justified, as Switzerland has one of the lowest mortality rates for cervical cancer worldwide (1,7/100 000; National Institute for Cancer Epidemiology and Registration; http://www.nicer. org/en/statistics-atlas/cancer-mortality, accessed on June 21, 2018). High standards of cytology have to be maintained and a low falsepositive rate is essential, as positive cytology results cause anxiety and possibly unnecessary colposcopy examinations. Different quality control measures are suggested for cervical cytology, one of which is cytohistological correlation of positive and/or discordant cases. 1 Nabothian cysts (also called mucinous retention cysts or epithelial cysts) are frequent at the squamocolumnar junction (SCJ), an anatomical point of the cervix that is the target of brush sampling during cervical screening cytology. Inspissated mucus contained inside these cysts may exhibit a granular character or can be filled with granulocyte fragments, resembling tumor diathesis (TD), a key cytological feature of frankly invasive carcinoma. 2 Moreover, necrotic debris in glands colonized by high-grade squamous intraepithelial lesions (H-SIL), may also mimic TD.We report here, for the first time, an intriguing case that came to our attention during a discussion about potential mimickers of TD-like material in the Papanicolaou test (PAP test) cytology. | CASE HISTORYA 32-year-old woman had been followed for several years due to a history of cervical dysplasia. On the last routine Pap test smear, atypical squamous cells consistent with H-SIL were identified along with TD-like material, thus...

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“…Radioiodine uptake in cystic lesions is reported. It is seen in ovarian dermoid or struma ovarii,[ 13 ] nabothian cysts,[ 14 ] renal cysts,[ 15 ] ovarian cysts,[ 16 ] bronchogenic cysts,[ 17 ] and pleuropericardial cysts. [ 18 ] Till date, there is no literature regarding radioiodine uptake in case of simple cysts in the liver.…”

Section: Discussionmentioning

confidence: 99%

Unusual false positive radioiodine uptake on 131 I whole body scintigraphy in three unrelated organs with different pathologies in patients of differentiated thyroid carcinoma: A case series

et al. 2016

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Three cases with unusual false positive radioiodine uptake in three different organs and pathologies (infective old fibrotic lesion in the lung, simple liver cyst, and benign breast lesion) on iodine-131 (131I) whole body scintigraphy. Clinicoradiological correlation was undertaken in all three cases and the pathologies were ascertained. In all the three cases, single-photon emission computerized tomography-computed tomography (SPECT-CT) and ancillary imaging modalities were employed and were helpful in arriving at the final diagnosis.

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Nabothian Cyst a Predominant Cause of False-Positive Iodine Uptake in Uterus

Abstract: Iodine uptake in the uterus is frequently found if pelvic SPECT/CT is performed. Nabothian cysts are a predominant cause of iodine uptake in the uterine cervix.

Cited by 13 publications

References 21 publications

Pictorial Review of False-Positive Results on Radioiodine Scintigrams of Patients with Differentiated Thyroid Cancer

Pictorial Review of False-Positive Results on Radioiodine Scintigrams of Patients with Differentiated Thyroid Cancer

Nabothian cyst content: A potential pitfall for the diagnosis of invasive cancer on Pap test cytology

Unusual false positive radioiodine uptake on 131 I whole body scintigraphy in three unrelated organs with different pathologies in patients of differentiated thyroid carcinoma: A case series

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