open access

Vol 20, No 1 (2017)
Original articles
Published online: 2016-11-30
Submitted: 2016-08-03
Accepted: 2016-09-14
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Semi-quantitative method for the assessment of focal lesions in parathyroid scintigraphy with relation to histopathology: a prospective study

Maria Henryka Listewnik, Hanna Piwowarska-Bilska, Mirela Kurantowicz, Marek Ostrowski, Andrzej Borowiecki, Krzysztof Safranow, Krystyna Jasiakiewicz, Jacek Iwanowski, Maria Chosia, Maria Laszczyńska, Bożena Birkenfeld
DOI: 10.5603/NMR.a2016.0038
·
Pubmed: 27813617
·
Nucl. Med. Rev 2017;20(1):18-24.

open access

Vol 20, No 1 (2017)
Original articles
Published online: 2016-11-30
Submitted: 2016-08-03
Accepted: 2016-09-14

Abstract

BBACKGROUND: The aim of this paper was to analyse our own semi-quantitative method of assessing focal lesions localised in pre-operative diagnostic scintigraphy of primary hyperparathyroidism (PHPT) using 99mTc-MIBI with washout and comparing these data with the result of the histopathological examination (HP).

MATERIAL AND METHODS: A total of 40 (37 female, 3 male, average age 58.7 years) patients with a suspicion of PHPT were enrolled for prospective analysis. Dual phase planar and SPECT/CT examination with 99mTc-MIBI were performed. The tumour to background ratios in the 10th and 120th minute were calculated (TBR10 and TBR120) on the basis of the planar acquisition. PTH, ionised calcium and phosphate levels were measured. Parathyroid surgery alone or combined with subtotal/total thyreoidectomy was conducted in 23 (57.5%) and 17 (42.5%) patients, respectively. A HP was performed in all patients.

RESULTS: Average concentration of PTH in the whole group was 243.95 pg/ml. There was a statistically significant correlation between medians of PTH concentration and parathyroid histopathological results (p = 0.01). A total of 45 lesions of increased uptake were found in 32 (80.0%) and 34 (85%) patients in the early phase and the delayed phase, respectively. The post-operative material contained 20 (44.5%) parathyroid adenomas, 11 (24.5%) cases of hyperplasia, 2 (4.4%) cancers, 4 (8.9%) cases of normal parathyroid tissue, 2 (4.4%) lymph nodes and 6 (13.3%) cases of thyroid gland tissue. The medians of TBR10 and TBR120 for lesions examined in the HP were respectively: 3.64 and 2.59 for adenoma; 3.08 and 2.18 for hyperplasia; 7.7 and 5.5 for parathyroid cancer, 4.89 and 3.16 for normal tissue and 5.26 and 2.95 for lymph nodes or thyroid gland tissue. A high correlation coefficient of TBR10 to TBR120 in the parathyroid adenoma and parathyroid hyperplasia groups was observed with r = 0.867 and r = 0.964, respectively. The ρr correlation coefficient of TBR10 to TBR120 for normal parathyroid was 0.4. There was a statistically significant association between the HP and TBR10 medians (p = 0.047), but not between histopathology and TBR120 medians (p = 0.840).

CONCLUSIONS: The washout technique in pre-operative 99mTc-MIBI scintigraphy is effective in detecting lesions of the parathyroid (cancer, adenoma, hyperplasia, normal tissue of the parathyroid). Parathyroid cancers in semi-quantitative analysis were characterised by a slightly higher TBR. However, it is impossible to differentiate lesions based on this data. Histopathology results are significantly associated with TBR and PTH.

Abstract

BBACKGROUND: The aim of this paper was to analyse our own semi-quantitative method of assessing focal lesions localised in pre-operative diagnostic scintigraphy of primary hyperparathyroidism (PHPT) using 99mTc-MIBI with washout and comparing these data with the result of the histopathological examination (HP).

MATERIAL AND METHODS: A total of 40 (37 female, 3 male, average age 58.7 years) patients with a suspicion of PHPT were enrolled for prospective analysis. Dual phase planar and SPECT/CT examination with 99mTc-MIBI were performed. The tumour to background ratios in the 10th and 120th minute were calculated (TBR10 and TBR120) on the basis of the planar acquisition. PTH, ionised calcium and phosphate levels were measured. Parathyroid surgery alone or combined with subtotal/total thyreoidectomy was conducted in 23 (57.5%) and 17 (42.5%) patients, respectively. A HP was performed in all patients.

RESULTS: Average concentration of PTH in the whole group was 243.95 pg/ml. There was a statistically significant correlation between medians of PTH concentration and parathyroid histopathological results (p = 0.01). A total of 45 lesions of increased uptake were found in 32 (80.0%) and 34 (85%) patients in the early phase and the delayed phase, respectively. The post-operative material contained 20 (44.5%) parathyroid adenomas, 11 (24.5%) cases of hyperplasia, 2 (4.4%) cancers, 4 (8.9%) cases of normal parathyroid tissue, 2 (4.4%) lymph nodes and 6 (13.3%) cases of thyroid gland tissue. The medians of TBR10 and TBR120 for lesions examined in the HP were respectively: 3.64 and 2.59 for adenoma; 3.08 and 2.18 for hyperplasia; 7.7 and 5.5 for parathyroid cancer, 4.89 and 3.16 for normal tissue and 5.26 and 2.95 for lymph nodes or thyroid gland tissue. A high correlation coefficient of TBR10 to TBR120 in the parathyroid adenoma and parathyroid hyperplasia groups was observed with r = 0.867 and r = 0.964, respectively. The ρr correlation coefficient of TBR10 to TBR120 for normal parathyroid was 0.4. There was a statistically significant association between the HP and TBR10 medians (p = 0.047), but not between histopathology and TBR120 medians (p = 0.840).

CONCLUSIONS: The washout technique in pre-operative 99mTc-MIBI scintigraphy is effective in detecting lesions of the parathyroid (cancer, adenoma, hyperplasia, normal tissue of the parathyroid). Parathyroid cancers in semi-quantitative analysis were characterised by a slightly higher TBR. However, it is impossible to differentiate lesions based on this data. Histopathology results are significantly associated with TBR and PTH.

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Keywords

hyperparathyroidism, adenoma, localization, nuclear scanning, sestamibi

About this article
Title

Semi-quantitative method for the assessment of focal lesions in parathyroid scintigraphy with relation to histopathology: a prospective study

Journal

Nuclear Medicine Review

Issue

Vol 20, No 1 (2017)

Pages

18-24

Published online

2016-11-30

DOI

10.5603/NMR.a2016.0038

Pubmed

27813617

Bibliographic record

Nucl. Med. Rev 2017;20(1):18-24.

Keywords

hyperparathyroidism
adenoma
localization
nuclear scanning
sestamibi

Authors

Maria Henryka Listewnik
Hanna Piwowarska-Bilska
Mirela Kurantowicz
Marek Ostrowski
Andrzej Borowiecki
Krzysztof Safranow
Krystyna Jasiakiewicz
Jacek Iwanowski
Maria Chosia
Maria Laszczyńska
Bożena Birkenfeld

References (24)
  1. Glynn N, Lynn N, Donagh C, et al. The utility of 99mTc-sestamibi scintigraphy in the localisation of parathyroid adenomas in primary hyperparathyroidism. Ir J Med Sci. 2011; 180(1): 191–194.
  2. Noda S, Onoda N, Kashiwagi S, et al. Strategy of operative treatment of hyperparathyroidism using US scan and (99m)Tc-MIBI SPECT/CT. Endocr. J. 2014; 61(3): 225–230.
  3. Grosso I, Sargiotto A, D'Amelio P, et al. Preoperative localization of parathyroid adenoma with sonography and 99mTc-sestamibi scintigraphy in primary hyperparathyroidism. J Clin Ultrasound. 2007; 35(4): 186–190.
  4. Civelek AC, Ozalp E, Donovan P, et al. Prospective evaluation of delayed technetium-99m sestamibi SPECT scintigraphy for preoperative localization of primary hyperparathyroidism. Surgery. 2002; 131(2): 149–157.
  5. Qiu ZL, Wu Bo, Shen CT, et al. Dual-phase (99m)Tc-MIBI scintigraphy with delayed neck and thorax SPECT/CT and bone scintigraphy in patients with primary hyperparathyroidism: correlation with clinical or pathological variables. Ann Nucl Med. 2014; 28(8): 725–735.
  6. Treglia G, Sadeghi R, Schalin-Jäntti C, et al. Detection rate of (99m) Tc-MIBI single photon emission computed tomography (SPECT)/CT in preoperative planning for patients with primary hyperparathyroidism: A meta-analysis. Head Neck. 2016; 38 Suppl 1: E2159–E2172.
  7. Takebayashi S, Hidai H, Chiba T, et al. Hyperfunctional parathyroid glands with 99mTc-MIBI scan: semiquantitative analysis correlated with histologic findings. J Nucl Med 1999; 40: 1792–1797. PubMed PMID. ; 10565772.
  8. Cheon M, Choi JY, Chung JH, et al. Differential findings of tc-99m sestamibi dual-phase parathyroid scintigraphy between benign and malignant parathyroid lesions in patients with primary hyperparathyroidism. Nucl Med Mol Imaging. 2011; 45(4): 276–284.
  9. Scheiner JD, Dupuy DE, Monchik JM, et al. Pre-operative localization of parathyroid adenomas: a comparison of power and colour Doppler ultrasonography with nuclear medicine scintigraphy. Clin Radiol. 2001; 56(12): 984–988.
  10. Akbaba G, Berker D, Isik S, et al. A comparative study of pre-operative imaging methods in patients with primary hyperparathyroidism: ultrasonography, 99mTc sestamibi, single photon emission computed tomography, and magnetic resonance imaging. J. Endocrinol. Invest. 2012; 35(4): 359–364.
  11. Lezaic L, Rep S, Sever MJ, et al. ¹⁸F-Fluorocholine PET/CT for localization of hyperfunctioning parathyroid tissue in primary hyperparathyroidism: a pilot study. Eur. J. Nucl. Med. Mol. Imaging. 2014; 41(11): 2083–2089.
  12. Pata G, Casella C, Magri GC, et al. Financial and clinical implications of low-energy CT combined with 99m Technetium-sestamibi SPECT for primary hyperparathyroidism. Ann. Surg. Oncol. 2011; 18(9): 2555–2563.
  13. Ciappuccini R, Morera J, Pascal P, et al. Dual-phase 99mTc sestamibi scintigraphy with neck and thorax SPECT/CT in primary hyperparathyroidism: a single-institution experience. Clin Nucl Med. 2012; 37(3): 223–228.
  14. Tokmak H, Demirkol MO, Alagöl F, et al. Clinical impact of SPECT-CT in the diagnosis and surgical management of hyper-parathyroidism. Int J Clin Exp Med. 2014; 7(4): 1028–1034.
  15. Sharma J, Mazzaglia P, Milas M, et al. Radionuclide imaging for hyperparathyroidism (HPT): which is the best technetium-99m sestamibi modality? Surgery. 2006; 140(6): 856–63; discussion 863.
  16. Do Cao C, Aubert S, Trinel C, et al. Parathyroid carcinoma: Diagnostic criteria, classification, evaluation. Ann. Endocrinol. (Paris). 2015; 76(2): 165–168.
  17. Leupe PK, Delaere PR, Vander Poorten VL, et al. Pre-operative imaging in primary hyperparathyroidism with ultrasonography and sestamibi scintigraphy. B-ENT. 2011; 7(3): 173–180.
  18. Pyzik AJ, Matyjaszek-Matuszek B, Zwolak A, et al. Parathyroid cancer - difficult diagnosis - a case report. Nucl Med Rev Cent East Eur. 2016; 19(1): 46–50.
  19. Wei WJ, Shen CT, Song HJ, et al. Comparison of SPET/CT, SPET and planar imaging using 99mTc-MIBI as independent techniques to support minimally invasive parathyroidectomy in primary hyperparathyroidism: A meta-analysis. Hell J Nucl Med. 2015; 18(2): 127–135.
  20. Hughes DT, Sorensen MJ, Miller BS, et al. The biochemical severity of primary hyperparathyroidism correlates with the localization accuracy of sestamibi and surgeon-performed ultrasound. J. Am. Coll. Surg. 2014; 219(5): 1010–1019.
  21. Lavely WC, Goetze S, Friedman KP, et al. Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy. J. Nucl. Med. 2007; 48(7): 1084–1089.
  22. Oksüz MO, Dittmann H, Wicke C, et al. Accuracy of parathyroid imaging: a comparison of planar scintigraphy, SPECT, SPECT-CT, and C-11 methionine PET for the detection of parathyroid adenomas and glandular hyperplasia. Diagn Interv Radiol. 2011; 17(4): 297–307.
  23. Shafiei B, Hoseinzadeh S, Fotouhi F, et al. Preoperative ⁹⁹mTc-sestamibi scintigraphy in patients with primary hyperparathyroidism and concomitant nodular goiter: comparison of SPECT-CT, SPECT, and planar imaging. Nucl Med Commun. 2012; 33(10): 1070–1076.
  24. Krausz Y, Bettman L, Guralnik L, et al. Technetium-99m-MIBI SPECT/CT in primary hyperparathyroidism. World J Surg. 2006; 30(1): 76–83.

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