open access

Vol 22, No 1 (2019)
Research paper
Submitted: 2018-11-05
Accepted: 2018-12-11
Published online: 2019-01-31
Get Citation

Relationship between parathyroid gland scintigraphy and its histopathology, oxyphil cell content and volume: a retrospective study

Małgorzata Kobylecka1, Łukasz Koperski2, Witold Chudziński3, Paweł Pihowicz2, Joanna Mączewska1, Maria Teresa Płazińska1, Magdalena Bogdańska2, Leszek Królicki1
DOI: 10.5603/NMR.2019.0005
·
Pubmed: 31482540
·
Nucl. Med. Rev 2019;22(1):29-33.
Affiliations
  1. Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
  2. Department of Pathology, Medical University of Warsaw, Warsaw, Poland
  3. Department of General, Endocrine and Vascular Surgery, Medical University of Warsaw

open access

Vol 22, No 1 (2019)
Original articles
Submitted: 2018-11-05
Accepted: 2018-12-11
Published online: 2019-01-31

Abstract

BACKGROUND: Mechanisms that are responsible for positive 99mTc-MIBI uptake in parathyroid glands are not clearly understood, some authors suggest there is a correlation between 99mTc MIBI accumulation and oxyphil cell content or parathyroid gland volume. The aim of our work was to assess the relationship between the pathological structure of parathyroids, their volume, oxyphil cell content and parathyroid 99mTc-MIBI retention.

MATERIAL AND METHODS: A total of 62 hyperfunctioning parathyroid glands in 46 patients were retrospectively analyzed. Preoperative 99mTc-MIBI scintigraphy was performed according to the double-phase and subtraction protocol. After surgery all glands were evaluated histologically, oxyphil cell content was assessed and volume of each excised gland was calculated.

RESULTS: Scintigraphy was positive in 41 of 62 parathyroid glands (66%). The median volume of positive glands was larger than that of negative glands (1.33 ml vs 0.7 ml, p = 0.015). Of the parathyroid lesions, there were 14 (22.6%) cases of nodular hyperplasia, 23 (37.1%) cases of diffuse hyperplasia, and 25 (40.3%) cases of adenomas. A high (≥ 25%) oxyphil cell content was found in 16 glands (25.8%) and a low ( < 25%) oxyphil cell content in 46 (74.2%) glands. Histopathology of parathyroid glands was related to the scintigraphy result (p = 0.002), but not to the 99mTc-MIBI uptake pattern (p = 0.868). The overall result of scintigraphy was not related to the oxyphil cell content (p = 0.797). 99mTc-MIBI uptake pattern wasn’t related to the oxyphil cell content (p = 0.833). In general, parathyroid lesions with low oxyphil cell content were larger than parathyroid glands with high oxyphil cell content (1.33 ml vs 0.5 ml, respectively; p = 0.01). The median volume of parathyroids containing a high number of oxyphil cells and having a prolonged 99mTc-MIBI retention was larger than those without prolonged 99mTc-MIBI retention (1.62 ml vs 0.3 ml, respectively; p = 0.008). The median volume of parathyroids with low oxyphil cells content and showing prolonged 99mTc-MIBI retention was larger than those without prolonged 99mTc-MIBI retention (1.95 ml vs 1.07 ml, respectively; p = 0.014).

CONCLUSIONS: Our findings suggest that a positive scintigraphy result depends on parathyroid histopathology and gland volume and does not depend on the presence of oxyphil cells. Prolonged 99mTc-retention is not related to the parathyroid gland histopathology and the presence of oxyphil cells but to the gland volume.

Abstract

BACKGROUND: Mechanisms that are responsible for positive 99mTc-MIBI uptake in parathyroid glands are not clearly understood, some authors suggest there is a correlation between 99mTc MIBI accumulation and oxyphil cell content or parathyroid gland volume. The aim of our work was to assess the relationship between the pathological structure of parathyroids, their volume, oxyphil cell content and parathyroid 99mTc-MIBI retention.

MATERIAL AND METHODS: A total of 62 hyperfunctioning parathyroid glands in 46 patients were retrospectively analyzed. Preoperative 99mTc-MIBI scintigraphy was performed according to the double-phase and subtraction protocol. After surgery all glands were evaluated histologically, oxyphil cell content was assessed and volume of each excised gland was calculated.

RESULTS: Scintigraphy was positive in 41 of 62 parathyroid glands (66%). The median volume of positive glands was larger than that of negative glands (1.33 ml vs 0.7 ml, p = 0.015). Of the parathyroid lesions, there were 14 (22.6%) cases of nodular hyperplasia, 23 (37.1%) cases of diffuse hyperplasia, and 25 (40.3%) cases of adenomas. A high (≥ 25%) oxyphil cell content was found in 16 glands (25.8%) and a low ( < 25%) oxyphil cell content in 46 (74.2%) glands. Histopathology of parathyroid glands was related to the scintigraphy result (p = 0.002), but not to the 99mTc-MIBI uptake pattern (p = 0.868). The overall result of scintigraphy was not related to the oxyphil cell content (p = 0.797). 99mTc-MIBI uptake pattern wasn’t related to the oxyphil cell content (p = 0.833). In general, parathyroid lesions with low oxyphil cell content were larger than parathyroid glands with high oxyphil cell content (1.33 ml vs 0.5 ml, respectively; p = 0.01). The median volume of parathyroids containing a high number of oxyphil cells and having a prolonged 99mTc-MIBI retention was larger than those without prolonged 99mTc-MIBI retention (1.62 ml vs 0.3 ml, respectively; p = 0.008). The median volume of parathyroids with low oxyphil cells content and showing prolonged 99mTc-MIBI retention was larger than those without prolonged 99mTc-MIBI retention (1.95 ml vs 1.07 ml, respectively; p = 0.014).

CONCLUSIONS: Our findings suggest that a positive scintigraphy result depends on parathyroid histopathology and gland volume and does not depend on the presence of oxyphil cells. Prolonged 99mTc-retention is not related to the parathyroid gland histopathology and the presence of oxyphil cells but to the gland volume.

Get Citation

Keywords

parathyroid scintigraphy; 99mTc-MIBI; oxyphil cells; parathyroid adenoma; parathyroid hyperplasia; parathyroid volume

About this article
Title

Relationship between parathyroid gland scintigraphy and its histopathology, oxyphil cell content and volume: a retrospective study

Journal

Nuclear Medicine Review

Issue

Vol 22, No 1 (2019)

Article type

Research paper

Pages

29-33

Published online

2019-01-31

Page views

892

Article views/downloads

901

DOI

10.5603/NMR.2019.0005

Pubmed

31482540

Bibliographic record

Nucl. Med. Rev 2019;22(1):29-33.

Keywords

parathyroid scintigraphy
99mTc-MIBI
oxyphil cells
parathyroid adenoma
parathyroid hyperplasia
parathyroid volume

Authors

Małgorzata Kobylecka
Łukasz Koperski
Witold Chudziński
Paweł Pihowicz
Joanna Mączewska
Maria Teresa Płazińska
Magdalena Bogdańska
Leszek Królicki

References (25)
  1. Ishibashi M, Nishida H, Hiromatsu Y, et al. Comparison of technetium-99m-MIBI, technetium-99m-tetrofosmin, ultrasound and MRI for localization of abnormal parathyroid glands. J Nucl Med. 1998; 39(2): 320–324.
  2. Mitchell BK, Merrell RC, Kinder BK. Localization studies in patients with hyperparathyroidism. Surg Clin North Am. 1995; 75(3): 483–498.
  3. Touska P, Elstob A, Rao ND, et al. SPECT-CT-guided ultrasound for parathyroid adenoma localisation - a one stop approach. J Nucl Med Technol. 2018 [Epub ahead of print].
  4. Botushanova AD, Botushanov NP, Yaneva MP. Nuclear Medicine Methods for Evaluation of Abnormal Parathyroid Glands in Patients with Primary and Secondary Hyperparathyroidism. Folia Med (Plovdiv). 2017; 59(4): 396–404.
  5. Torregrosa JV, Palomar MR, Pons F, et al. Has double-phase MIBI scintigraphy usefulness in the diagnosis of hyperparathyroidism? Nephrol Dial Transplant. 1998; 13 Suppl 3: 37–40.
  6. Biaco I, Carril J, Banzo I, et al. Double-Phase Tc-99m Sestamibi Scintigraphy in the Preoperative Location of Lesions Causing Hyperparathyroidism. Clinical Nuclear Medicine. 1998; 23(5): 291–297.
  7. Norman J, Chheda H, Farrell C. Minimally invasive parathyroidectomy for primary hyperparathyroidism: decreasing operative time and potential complications while improving cosmetic results. Am Surg. 1998; 64(5): 391–5; discussion 395.
  8. Martin D, Rosen IB, Ichise M. Evaluation of single isotope technetium 99M-sestamibi in localization efficiency for hyperparathyroidism. Am J Surg. 1996; 172(6): 633–636.
  9. Olaizola C, Zingraff J, Fajardo L, et al. (99m)Tc-sestamibi parathyroid scintigraphy in chronic haemodialysis patients: static and dynamic explorations Nephrology, Dialysis, Transplantation. 2000; 15(8): 1201–1206.
  10. Pham TH, Sterioff S, Mullan BP, et al. Sensitivity and utility of parathyroid scintigraphy in patients with primary versus secondary and tertiary hyperparathyroidism. World J Surg. 2006; 30(3): 327–332.
  11. Hindié E, Ugur O, Fuster D, et al. Parathyroid Task Group of the EANM. 2009 EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging. 2009; 36(7): 1201–1216.
  12. Hoang TD, Jani AG, Mai VQ, et al. ASSOCIATIONS OF SERUM IONIZED CALCIUM, PHOSPHATE, AND PTH LEVELS WITH TECHNETIUM-99 SESTAMIBI PARATHYROID SPECT/CT SCAN IN PRIMARY HYPERPARATHYROIDISM. Endocr Pract. 2018 [Epub ahead of print].
  13. Ghandur-Mnaymneh L, Kimura N. The parathyroid adenoma. A histological definition with a study of 172 cases of primary hyperparathyroidism. Am J Pathol. 1984; 115: 70–83.
  14. Carpentier A, Jeannotte S, Verreault J, et al. Preopereative localization of parathyroid lesions in hyperparathyroidism: relationship between Technetium 99mTc-MIBI uptake and Oxyphil Cell Content. J Nucl Med. 1998; 39: 1441–1444.
  15. Fujimoto N, Itoh K, Kishikawa H, et al. [Preoperative localization of enlarged parathyroid glands by 99mTc-MIBI scintigraphy]. Nihon Hinyokika Gakkai Zasshi. 1997; 88(9): 795–800.
  16. Jeanguillaume C, Ureña P, Hindié E, et al. Secondary hyperparathyroidism: detection with I-123-Tc-99m-Sestamibi subtraction scintigraphy versus US. Radiology. 1998; 207(1): 207–213.
  17. Neumann DR, Esselstyn CB, Madera A, et al. Parathyroid detection in secondary hyperparathyroidism with 123I/99mTc-sestamibi subtraction single photon emission computed tomography. J Clin Endocrinol Metab. 1998; 83(11): 3867–3871.
  18. Wada A, Sugihara M, Sugimura K, et al. Magnetic resonance imaging (MRI) and technetium-99m-methoxyisonitrile (MIBI) scintigraphy to evaluate the abnormal parathyroid gland and PEIT efficacy for secondary hyperparathyroidism. Radiat Med. 1999; 17(4): 275–282.
  19. Fujimoto N, Itoh K, Kishikawa H, et al. Preoperative localization of enlarged parathyroid glands by 99mTc-MIBI scintigraphy. Nihon Hinyokika Gakkai Zasshi. 1997; 88(9): 795–800.
  20. Pons F, Torregrosa JV, Vidal-Sicart S, et al. Preoperative parathyroid gland localization with technetium-99m sestamibi in secondary hyperparathyroidism. European Journal of Nuclear Medicine and Molecular Imaging. 1997; 24(12): 1494–1498.
  21. Blocklet D, Martin P, Schoutens A, et al. Presurgical localization of abnormal parathyroid glands using a single injection of technetium-99m methoxyisobutylisonitrile: Comparison of different techniques including factor analysis of dynamic structures. European Journal of Nuclear Medicine. 1997; 24(1): 46–51.
  22. Cinti S, Sbarbati A. Ultrastructure of human parathyroid cells in health and disease. Microsc Res Tech. 1995; 32(2): 164–179.
  23. Joujoux JM, Marty-Double C, Godlewski G, et al. [Morphological aspects of parathyroid hyperplasia in patients with chronic renal insufficiency on dialysis]. Ann Pathol. 1986; 6(3): 164–169.
  24. Allen TB, Thorburn KM. The oxyphil cell in abnormal parathyroid glands. A study of 114 cases. Arch Pathol Lab Med. 1981; 105(8): 421–427.
  25. Arbab AS, Koizumi K, Hemmi A, et al. Tc-99m-MIBI scintigraphy for detecting parathyroid adenoma and hyperplasia. Ann Nucl Med. 1997; 11(1): 45–49.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Świętokrzyska 73 street, 80–180 Gdańsk, Poland

phone: +48 58 320 94 94, fax: +48 58 320 94 60, e-mail: viamedica@viamedica.pl