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Nuklearmedizin 2009; 48(04): 144-152
DOI: 10.3413/nukmed-0240
Original Article
Schattauer GmbH

MIBI scintigraphy in hypofunctioning thyroid nodules

Can it predict the dignity of the lesion?MIBI-Szintigraphie kalter SchilddrüsenknotenKann sie die Dignität kalter Knoten vorhersagen?
P. Theissen
1   Department of Nuclear Medicine, University of Cologne, Germany
,
M. Schmidt
1   Department of Nuclear Medicine, University of Cologne, Germany
,
T. Ivanova
1   Department of Nuclear Medicine, University of Cologne, Germany
,
M. Dietlein
1   Department of Nuclear Medicine, University of Cologne, Germany
,
H. Schicha
1   Department of Nuclear Medicine, University of Cologne, Germany
› Author Affiliations
Further Information

Publication History

received: 13 February 2009

accepted in revised form: 27 April 2009

Publication Date:
22 January 2018 (online)

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Summary

Aim: Several authors have investigated the value of technetium-MIBI scanning to predict the dignity of hypofunctioning, cold thyroid nodules (HTN) in regions with differing levels of iodine supply. They concluded that an MIBI scan can exclude thyroid malignancy, although comparisons between the studies are of limited value owing to differences in methodology and wide variations in patient selection criteria. The present study investigates whether the above claim is also valid in Germany, a country with a long-standing and persistent, mild iodine deficiency and a high incidence of nodules in large goiters with a low prevalence of malignancy. Patients, methods: The study compares the results of 99mTc-MIBI scintigraphy (incl. SPECT and planar images) in HTN (MIBI) with those of fine-needle aspiration biopsy (FNAB) and histology. Of 154 consecutive patients (121 women, 33 men; mean age 56 ± 12 years), 73 underwent thyroid surgery from which the results of FNAB and MIBI were assessed. Selection criteria were risk estimation or conditions limiting the feasibility of FNAB. The mean thyroid volume was 42 ± 25 ml, with 2.1 ± 1.4 nodules per patient. Results: Histology revealed thyroid malignancies in 8 out of 73 patients (11.0%). The negative predictive value for MIBI was 97%, which is comparable to FNAB (94%). However, in 19.5% of patients FNAB was indeterminate. Lower specificity (54%) and low positive predictive value (19%) showed that MIBI accumulation cannot differentiate between malignant and benign thyroid nodules. However, comparison with cytological and/or histological findings indicated that it could distinguish between lesions with differing rates of mitochondrial metabolism. Conclusion: Even in areas of former or mild iodine deficiency MIBI forms a basis for choosing between wait-and-see and surgical strategies if FNAB is unfeasible or not representative. However, even for pathological MIBI results, the prevalence of malignancy is not very high.

Zusammenfassung

Einige Autoren untersuchten den Wert der Technetium-MIBI-Szintigraphie zur Dignitätbestimmung kalter Schilddrüsenknoten in Regionen mit unterschiedlicher Iodversorgung. Nach diesen Studien ermöglicht MIBI den Ausschluss eines Schilddrüsen malignoms, obwohl sie aufgrund unterschiedlicher Methodik und Patientenauswahl nur eingeschränkt vergleichbar sind. Ziel: Wir prüften, ob sich die Ergebnisse auf die Verhältnisse in Deutschland mit lange bestehendem, noch geringem Iodmangel und einer hohen Inzidenz von Knoten in großen Schilddrüsen übertragen lassen. Patienten, Methoden: Ergebnisse der 99mTc-MIBISzintigraphie (inkl. SPECT und planaren Aufnahmen) bei kalten Knoten wurden mit denen der Feinnadelbiopsie (FNAB) und Histologie verglichen. Von einen Gesamtkollektiv aus 154 konsekutiven Patienten (121 Frauen, 33 Männer; Alter 56 ± 12 Jahre) ließen 73 eine Schilddrüsenoperation durchführen, wodurch die Ergebnisse von FNAB und MIBI überprüft werden konnten. Selektionskriterien für die MIBISzintigraphie waren auch eingeschränkte Voraussetzungen für die FNAB, z. B. bei mit einem Schilddrüsenvolumina bis 180 ml (im Mittel 42 ± 25 ml) mit mehrern Knoten (im Mittel 2,1 ± 1,4 pro Patient) und multiplen zystischen und regressiven Schilddrüsenveränderungen. Ergebnisse: Entsprechend der Selektionsktriterien erbrachte die Histologie eine relative niedrige Karzinomrate von 11%. Der negative prädiktive Wert der MIBI-Untersuchung war hoch (97%) und vergleichbar der FNAB (94%). Die FNAB aber war bei 19.5% der Patienten nicht be urteilbar. Die niedrige Spezifität (54%) und ein sehr niedriger positiver prädiktiver Wert (19%) zeigten, dass MIBI die Dignität von Schilddrüsenknoten nicht sicher bestimmen kann. Der Vergleich mit Zytologie bzw. Histologie ergab, dass die MIBI-Akkumulation vom mitochondrialen Stoffwechsel beeinflusst ist. Schlussfolgerung: MIBI-Szinti graphie sollte auch unter den deutschen Iodmangelbedingungen zur Strategiefestlegung (Abwarten oder Operation) beim kalten Knoten eingesetzt werden, wenn eine FNAB nicht möglich oder nicht repräsentativ ist. Bei pathologischem Ergebnis ist die Prävalenz eines Karzinoms aber nicht hoch.

Keywords

Methylisobutyisonitrile - scintigraphy - SPECT - hypofunctioning thyroid nodule - goiter

Schlüsselwörter

MIBI - Technetium-Methylisobutyisonitril - kalter Schilddrüsenknoten - Struma
 

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