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Clinical Trial
. 2016 Jun;43(6):1018-26.
doi: 10.1007/s00259-015-3285-1. Epub 2015 Dec 23.

Molecular imaging with (99m)Tc-MIBI and molecular testing for mutations in differentiating benign from malignant follicular neoplasm: a prospective comparison

L Giovanella  1 , A Campenni  2 , G Treglia  3 , F A Verburg  4 , P Trimboli  3   5 , L Ceriani  3 , M Bongiovanni  6
Affiliations
Clinical Trial

Molecular imaging with (99m)Tc-MIBI and molecular testing for mutations in differentiating benign from malignant follicular neoplasm: a prospective comparison

L Giovanella et al. Eur J Nucl Med Mol Imaging. 2016 Jun.

Abstract

Purpose: To compare mutation analysis of cytology specimens and (99m)Tc-MIBI thyroid scintigraphy for differentiating benign from malignant thyroid nodules in patients with a cytological reading of follicular neoplasm.

Methods: Patients ≥18 years of age with a solitary hypofunctioning thyroid nodule (≥10 mm), normal thyrotropin and calcitonin levels, and a cytological diagnosis of follicular neoplasm were prospectively enrolled. Mutation analysis and (99m)Tc-MIBI scintigraphy were performed and patients were subsequently operated on to confirm or exclude a malignant lesion. Mutations for KRAS, HRAS and NRAS and for BRAF and translocations of PAX8/PPARγ, RET/PTC1 and RET/PTC3 were investigated. Static thyroid scintigraphic images were acquired 10 and 60 min after intravenous injection of 200 MBq of (99m)Tc-MIBI and visually assessed. Additionally, the MIBI washout index was calculated using a semiquantitative method.

Results: In our series, 26 % of nodules with a follicular pattern on cytology were malignant with a prevalence of follicular carcinomas. (99m)Tc-MIBI scintigraphy was found to be significantly more accurate (positive likelihood ratio 4.56 for visual assessment and 12.35 for semiquantitative assessment) than mutation analysis (positive likelihood ratio 1.74). A negative (99m)Tc-MIBI scan reliably excluded malignancy.

Conclusion: In patients with a thyroid nodule cytologically diagnosed as a follicular proliferation, semiquantitative analysis of (99m)Tc-MIBI scintigraphy should be the preferred method for differentiating benign from malignant nodules. It is superior to molecular testing for the presence of differentiated thyroid cancer-associated mutations in fine-needle aspiration cytology sample material.

Keywords: 99mTc-MIBI; Fine-needle aspiration cytology; Follicular neoplasms; Molecular markers; Mutation analysis; Scintigraphy; Thyroid.

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Figures

Fig. 1
Fig. 1
Visual assessment of 99mTc-MIBI scintigraphy. a 99mTc-pertechnetate; b 99mTc-MIBI (early image); c 99mTc-MIBI (delayed image) Pattern 1 no early/delayed uptake within the nodule, pattern 2 early uptake with late decrease pattern 3 early uptake stable or increasing on delayed images
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References

    1. Giovanella L. Thyroid nodules: clinical management and differential diagnosis. Praxis (Bern 1994) 2009;98:83–90. doi: 10.1024/1661-8157.98.2.83. - DOI - PubMed
    1. Rosai J. Handling of thyroid follicular patterned lesions. Endocr Pathol. 2005;16:279–283. doi: 10.1385/EP:16:4:279. - DOI - PubMed
    1. Liu J, Singh B, Tallini G, Carlson DL, Katabi N, Shaha A, et al. Follicular variant of papillary thyroid carcinoma: a clinic-pathologic study of a problematic entity. Cancer. 2006;107:1255–1264. doi: 10.1002/cncr.22138. - DOI - PubMed
    1. Suster S. Thyroid tumors with a follicular growth pattern: problems in differential diagnosis. Arch Pathol Lab Med. 2006;130:984–988. - PubMed
    1. Samulski TD, Shutty C, LiVolsi VA, Montone K, Baloch Z. The reliability of thyroid nodule ultrasound features and size to predict malignancy in fine-needle aspiration specimens: practical utility for the evaluating pathologist. Diagn Cytopathol. 2015;43:471–477. doi: 10.1002/dc.23262. - DOI - PubMed

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