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Comparison of F-18 FDG-PET/CT and Tc-99m MIBI in the preoperative evaluation of cold thyroid nodules in the same patient group

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Abstract

Recent studies have reported that standardized uptake values of FDG-PET imaging might predict malignant thyroid nodules and can be used in the preoperative evaluation of thyroid lesions. The aim of our study was to evaluate FDG-PET imaging in patients with cold thyroid nodules and to compare the imaging findings with Tc-99m MIBI scans and with post-op histopathology results. Twenty-three patients (18F, 5M) with 24 nodules that were suspicious in ultrasound and cold in Tc-99m pertechnetate scan, were included in the study. Each nodule underwent sonographically guided fine-needle aspiration biopsy. FDG-PET and MIBI scans were performed with an interval of 3–5 days. All patients underwent thyroidectomy and their FDG-PET, and MIBI thyroid scan results were compared with post-thyroidectomy pathology results. Post-op histopathology results found 7 malignant and 17 benign nodules. Six of the seven malignant nodules had increased uptake, which were positive for malignancy in both PET and MIBI scans. Each imaging method used different radiopharmaceuticals but showed one false-negative result in two different patients. FDG-PET produced false positives in eight nodules and MIBI scans found false positives in four nodules. FDG-PET imaging and MIBI scan showed the same sensitivity in malignant nodule evaluation, but their specificity differed. As a result, we suggest that FDG-PET imaging is not superior to MIBI scanning in differentiating malignant from benign thyroid nodules. MIBI imaging should be the first choice in the preoperative evaluation of patients with cold thyroid nodules as an adjunct procedure to FNAB because of its low cost and availability. This imaging technique can be used routinely in patients who are reluctant to undergo FNAB.

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References

  1. E.K. Alexander, J.P. Heering, C.B. Benson, M.C. Frates, P.M. Doubilet, E.S. Cibas et al., Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J. Clin. Endocrinol. Metab. 87(11), 4924–4927 (2002)

    Article  CAS  PubMed  Google Scholar 

  2. E.L. Mazzaferri, Thyroid cancer in thyroid nodules: finding a needle in the haystack. Am. J. Med. 93, 359–362 (1992)

    Article  CAS  PubMed  Google Scholar 

  3. M.S. Cohen, N. Arslan, F. Dehdashti, G.M. Doherty, T.C. Lairmore, L.M. Brunt et al., Risk of malignancy in thyroid incidentalomas identified by fluorodeoxyglucose-positron emission tomography. Surgery 130, 941–946 (2001)

    Article  CAS  PubMed  Google Scholar 

  4. E.L. Mazzaferi, Radioiodine and other treatments and outcomes, in Werner and Ingbar’s the thyroid: a fundamental and clinical text, 7th edn., ed. by L.E. Braverman, R.D. Utiger (JB Lippencott–Raven, Philadelphia, 1996), pp. 922–943

    Google Scholar 

  5. R. Siegel, C. DeSantis, K. Virgo, K. Stein, A. Mariotto, T. Smith et al., Cancer treatment and survivorship statistics. Cancer J. Clin. 62, 220–221 (2012)

    Article  Google Scholar 

  6. M.J. Yeung, J.W. Serpell, Management of the solitary thyroid nodule. Oncologist 13(2), 105–112 (2008)

    Article  PubMed  Google Scholar 

  7. B. Miller, BurkeyS, Lindberg G, Snyder WH 3rd, Nwariaku FE. Prevalence of malignancy within cytologically indeterminate thyroid nodules. Am. J. Surg. 188(5), 459–462 (2004)

    Article  PubMed  Google Scholar 

  8. V. Chaudhary, S. Bano, Imaging of the thyroid: recent advances. Indian J. Endocrinol. Metab. 16(3), 371–376 (2012)

    Article  PubMed Central  PubMed  Google Scholar 

  9. F.A. Verburg, F.F. Behrendt, F.M. Mottaghy, A. Heinzel, Cost-effectiveness of (99m)Tc-MIBI in the evaluation of thyroid nodules for malignancy: a new lease of life for an old radiopharmaceutical? Eur. J. Nucl. Med. Mol. Imag. 41(1), 102–104 (2014)

    Article  Google Scholar 

  10. A. Van den Bruel, A. Maes, T. De Potter, L. Mortelmans, M. Drijkoningen, B. Van Damme et al., Clinical relevance of thyroid fluorodeoxyglucose-whole body positron emission tomography incidentaloma. J. Clin. Endocrinol. Metab. 87(4), 1517–1520 (2002)

    Article  PubMed  Google Scholar 

  11. H. Nishimori, R. Tabah, M. Hickeson, J. How, Incidental thyroid “PETomas”: clinical significance and novel description of the self-resolving variant of focal FDG-PET thyroid uptake. Can. J. Surg. 54, 83–88 (2011)

    Article  PubMed Central  PubMed  Google Scholar 

  12. F. Boi, M.L. Lai, C. Deias, M. Piga, A. Serra, A. Uccheddu, G. Faa, S. Mariotti, The usefulness of 99mTc-SestaMIBI scan in the diagnostic evaluation of thyroid nodules with oncocytic cytology. Eur. J. Endocrinol. 149(6), 493–498 (2003)

    Article  CAS  PubMed  Google Scholar 

  13. A. Vattimo, P. Bertelli, M. Cintorino, L. Burroni, D. Volterrani, A. Vella et al., Hürthle cell tumor dwelling in hot thyroid nodules: preoperative detection with technetium-99m-MIBI dual-phase scintigraphy. J. Nucl. Med. 39(5), 822–825 (1998)

    CAS  PubMed  Google Scholar 

  14. P.E. Kinahan, J.W. Fletcher, Positron emission tomography-computed tomography standardized uptake values in clinical practice and assessing response to therapy. Semin. Ultrasound CT MR 31(6), 496–505 (2010)

    Article  PubMed Central  PubMed  Google Scholar 

  15. T.Y. Ho, M.J. Liou, K.J. Lin, T.C. Yen, Prevalence and significance of thyroid uptake detected by 18F-FDG PET. Endocrine 40(2), 297–302 (2011)

    Article  CAS  PubMed  Google Scholar 

  16. M. Klain, S. Maurea, A. Cuocolo, A. Colao, L. Marzano, G. Lombardi et al., Technetium-99m tetrofosmin imaging in thyroid diseases: comparison with Tc-99m-pertechnetate, thallium-201 and Tc-99m-methoxyisobutylisonitrile scans. Eur. J. Nucl. Med. 23(12), 1568–1574 (1996)

    Article  CAS  PubMed  Google Scholar 

  17. A.M. Schreiner, G.C. Yang, Adenomatoid nodules are the main cause for discrepant histology in 234 thyroid fine-needle aspirates reported as follicular neoplasm. Diagn. Cytopathol. 40(5), 375–379 (2012)

    Article  PubMed  Google Scholar 

  18. M.M. Sathekge, R.B. Mageza, M.N. Muthuphei, M.C. Modiba, R.C. Clauss, Evaluation of thyroid nodules with technetium-99m MIBI and technetium-99m pertechnetate. Head Neck 23, 305–310 (2001)

    Article  CAS  PubMed  Google Scholar 

  19. R. Sharma, K.L. Chakravarty, M. Tripathi, A. Kaushik, P. Bharti, M. Sahoo et al., Role of 99mTc-Tetrofosmin delayed scintigraphy and color Doppler sonography in characterization of solitary thyroid nodules. Nucl. Med. Commun. 28(11), 847–851 (2007)

    Article  PubMed  Google Scholar 

  20. C.C. Lubitz, S.S. Nagarkatti, W.C. Faquin, A.E. Samir, M.C. Hassan, G. Barbesino et al., Diagnostic yield of nondiagnostic thyroid nodules is not altered by timing of repeat biopsy. Thyroid 22, 590–594 (2012)

    Article  PubMed Central  PubMed  Google Scholar 

  21. A. Razfar, B.F. Branstetter 4th, A. Christopoulos, S.O. Lebeau, S.P. Hodak, D.E. Heron et al., Clinical usefulness of positron emission tomography-computed tomography in recurrent thyroid carcinoma. Arch. Otolaryngol. Head Neck Surg. 136(2), 120–125 (2010)

    Article  PubMed  Google Scholar 

  22. J.K. Chung, Y. So, J.S. Lee, C.W. Choi, S.M. Lim, D.S. Lee et al., Value of FDG PET in papillary thyroid carcinoma with negative I-131 whole-body scan. J. Nucl. Med. 40, 986–992 (1999)

    CAS  PubMed  Google Scholar 

  23. F. Bertagna, G. Treglia, A. Piccardo, E. Giovannini, G. Bosio, G. Biasiotto et al., 18F-FDG-PET/CT thyroid incidentalomas: a wide retrospective analysis in three Italian centres on the significance of focal uptake and SUV value. Endocrine 43, 678–685 (2013)

    Article  CAS  PubMed  Google Scholar 

  24. J.H. Yoon, J.Y. Kwak, H.J. Moon, M.J. Kim, E.K. Kim, The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy and the sonographic differences between benign and malignant thyroid nodules 3 > cm or larger. Thyroid 21(9), 993–1000 (2011)

    Article  PubMed  Google Scholar 

  25. L. Giovanella, S. Suriano, M. Maffioli, L. Ceriani, 18FDG-positron emission tomography/computed tomography (PET/CT) scanning in thyroid nodules with nondiagnostic cytology. Clinical Endocrinol. 74, 644–648 (2011)

    Article  Google Scholar 

  26. A. Sarikaya, G. Huseyinova, M.E. Irfanoglu, N. Erkmen, T.F. Cermik, S. Berkarda, The relationship between 99Tcm-sestamibi uptake and ultrastructural cell types of thyroid tumours. Nucl. Med. Commun. 22, 39–44 (2001)

    Article  CAS  PubMed  Google Scholar 

  27. L.M. Hurtado-López, C. Martínez-Duncker, Negative MIBI thyroid scans exclude differentiated and medullary thyroid cancer in 100 % of patients with hypofunctioning thyroid nodules. Eur. J. Nucl. Med. Mol. Imag. 34(10), 1701–1703 (2007)

    Article  Google Scholar 

  28. I. Foldes, A. Levay, G. Stotz, Comparative scanning of thyroid nodules with technetium-99m pertechnetate and technetium-99m methoxyisobutylisonitrile. Eur. J. Nucl. Med. 20, 330–333 (1993)

    Article  CAS  PubMed  Google Scholar 

  29. A. Wale, K.A. Miles, B. Young, C. Zammit, A. Williams, J. Quin et al., Combined (99m)Tc-methoxyisobutylisonitrile scintigraphy and fine-needle aspiration cytology offers an accurate and potentially cost-effective investigative strategy for the assessment of solitary or dominant thyroid nodules. Eur. J. Nucl. Med. Mol. Imag. 41(1), 105–115 (2014)

    Article  CAS  Google Scholar 

  30. G. Treglia, C. Caldarella, E. Saggiorato, L. Ceriani, F. Orlandi, M. Salvatori et al., Diagnostic performance of (99m)Tc-MIBI scan in predicting the malignancy of thyroid nodules: a meta-analysis. Endocrine 44, 70–78 (2013)

    Article  CAS  PubMed  Google Scholar 

  31. G. Leidig-Bruckner, G. Cichorowski, P. Sattler, T. Bruckner, B. Sattler, Evaluation of thyroid nodules–combined use of (99m)Tc-methylisobutylnitrile scintigraphy and aspiration cytology to assess risk of malignancy and stratify patients for surgical or nonsurgical therapy–a retrospective cohort study. Clin Endocrinol (Oxf). 76(5), 749–758 (2012)

    Article  CAS  PubMed  Google Scholar 

  32. L.F. De Geus-Oei, G.F. Pieters, J.J. Bonenkamp, A.H. Mudde, C.P. Bleeker-Rovers, F.H. Corstens et al., 18F-FDG PET reduces unnecessary hemithyroidectomies for thyroid nodules with inconclusive cytologic results. J. Nucl. Med. 47(5), 770–775 (2006)

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpasa, Fatih, Istanbul, Turkey

    Sait Sager, Betul Vatankulu, Ezgi Erdogan, Sanem Mut, Kerim Sonmezoglu & Bedii Kanmaz

  2. Department of Endocrine Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey

    Serkan Teksoz

  3. Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey

    Tulin Ozturk

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  1. Sait Sager
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  2. Betul Vatankulu
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Correspondence to Sait Sager.

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Sager, S., Vatankulu, B., Erdogan, E. et al. Comparison of F-18 FDG-PET/CT and Tc-99m MIBI in the preoperative evaluation of cold thyroid nodules in the same patient group. Endocrine 50, 138–145 (2015). https://doi.org/10.1007/s12020-015-0580-3

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  • DOI: https://doi.org/10.1007/s12020-015-0580-3

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