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

Abstract

INTRODUCTION:

Parathyroid sestamibi scan is routinely performed before parathyroid surgery. A large number of thyroid cancers take up 99mTc-sestamibi (MIBI). Since 2001, thyroid nodules discovered on sestamibi, nodules >2 cm, and/or with suspicious criteria were resected. The aim of this study was to evaluate the results of this policy.

METHODS:

All patients operated on for hyperparathyroidism, with a MIBI and cervical ultrasonography (US) with a thyroid resection for nodule, were retrospectively included.

RESULTS:

From 2001 to 2013, 685 patients were operated on for hyperparathyroidism. Some 137 (85 % females) had both preoperative MIBI and cervical US and a thyroid resection. The mean age was 63.2 ± 12.8 years. Sixty-three patients had a total thyroidectomy and 74 a lobectomy. Thirty-six patients had a thyroid cancer. The median size of cancers was 6.5 mm (0.3-22 mm), and 23 (16.7 %) patients had microcarcinoma. Among the 137 patients, 44 (32 %) had a MIBI+ nodule including 22 cancers. Sixty-one percent of malignant nodules were MIBI+ (22/36). The median size of MIBI+ cancers was 15 mm (9-22 mm) versus 2 mm (0.3-17 mm) for MIBI- cancers (p = 0.03). Twenty-two percent of benign nodules were MIBI+ (22/101). Finally, the sensitivity, specificity, positive predictive value, and negative predictive value of MIBI were 61, 78, 50, and 85 %, respectively.

CONCLUSION:

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

• Authors: Tristan Greilsamer, Claire Blanchard, Niki Christou, Delphine Drui, Catherine Ansquer, Maelle Le Bras, Bertrand Cariou, Cécile Caillard, Emmanuelle Mourrain-Langlois, Anne Sophie Delemazure, Muriel Mathonnet, Françoise Kraeber-Bodéré, Eric Mirallié
• Journal: Langenbeck's archives of surgery (Langenbecks Arch Surg) Vol. 400 Issue 3 Pg. 313-8 (Apr 2015) ISSN: 1435-2451 [Electronic] Germany
• PMID: 25694271 (Publication Type: Journal Article, Observational Study)

Chemical References

• Radiopharmaceuticals
• Technetium Tc 99m Sestamibi

Topics

• Female
• Humans
• Hyperparathyroidism, Primary (diagnostic imaging, surgery)
• Incidental Findings
• Male
• Middle Aged
• Predictive Value of Tests
• Radionuclide Imaging
• Radiopharmaceuticals
• Retrospective Studies
• Sensitivity and Specificity
• Technetium Tc 99m Sestamibi
• Thyroid Neoplasms (diagnostic imaging, surgery)
• Thyroid Nodule (diagnostic imaging, surgery)
• Thyroidectomy
• Ultrasonography