Advertisement

Nuclear Medicine and Molecular Imaging

, Volume 45, Issue 4, pp 276–284 | Cite as

Differential Findings of Tc-99m Sestamibi Dual-Phase Parathyroid Scintigraphy Between Benign and Malignant Parathyroid Lesions in Patients with Primary Hyperparathyroidism

  • Miju Cheon
  • Joon Young ChoiEmail author
  • Jae-Hoon Chung
  • Ji Young Lee
  • Sook Kyung Cho
  • Jang Yoo
  • Soo Bin Park
  • Kyung-Han Lee
  • Byung-Tae Kim
Original Article

Abstract

Purpose

This study aimed to investigate the differential findings in clinical and biochemical features, and Tc-99m sestamibi (MIBI) dual-phase parathyroid scintigraphy for malignant and benign parathyroid lesions in patients with primary hyperparathyroidism.

Methods

Subjects were 102 parathyroid lesions from 91 patients with primary hyperparathyroidism. Scintigraphic findings included radioactivity grade, uptake pattern, uptake contour, lesion size on early and delayed images, and degree of washout. Clinical and biochemical features were also evaluated. Histopathology confirmed the final diagnosis for all the patients.

Results

Final diagnoses were 94 benign parathyroid lesions and 8 parathyroid carcinomas. The patients with parathyroid carcinoma were significantly older (p = 0.002) and had significantly higher serum parathyroid hormone concentrations than those with benign parathyroid lesions (p < 0.001). All malignant parathyroid lesions showed intense radioactivity similar to or greater than the submandibular gland activity on delayed images (p = 0.007), and little radioactivity difference between early and delayed images (p = 0.012). The cancer incidence for parathyroid lesions with both intense radioactivity and no washout was 17.0% (8/47). When parathyroid lesions with all of the above-mentioned findings were regarded as malignant, the cancer incidence significantly increased from 17.0% to 33.3% (8/24, p < 0.001).

Conclusion

For Tc-99m MIBI dual-phase parathyroid scintigraphy, uptake grade on delayed images and washout were significantly useful diagnostic criteria for differentiating benign from malignant parathyroid lesions, along with age and parathyroid hormone serum concentration.

Keywords

Primary hyperparathyroidism Parathyroid carcinoma Parathyroid adenoma Parathyroid hyperplasia Tc-99m Sestamibi Parathyroid scintigraphy 

Notes

Conflict of interest statement

All authors declare that they have no conflict of interest.

References

  1. 1.
    Cohn K, Silverman M, Corrado J, Sedgewick C. Parathyroid carcinoma: the Lahey Clinic experience. Surg. 1985;98:1095–100.Google Scholar
  2. 2.
    Hakaim AG, Esselstyn Jr CB. Parathyroid carcinoma: 50-year experience at The Cleveland Clinic Foundation. Cleve Clin J Med. 1993;60:331–5.PubMedGoogle Scholar
  3. 3.
    Wang CA, Gaz RD. Natural history of parathyroid carcinoma. Diagnosis, treatment, and results. Am J Surg. 1985;149:522–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Holmes EC, Morton DL, Ketcham AS. Parathyroid carcinoma: a collective review. Ann Surg. 1969;169:631–40.PubMedCrossRefGoogle Scholar
  5. 5.
    Koea JB, Shaw JH. Parathyroid cancer: biology and management. Surg Oncol. 1999;8:155–65.PubMedCrossRefGoogle Scholar
  6. 6.
    Agarwal G, Dhingra S, Mishra SK, Krishnani N. Implantation of parathyroid carcinoma along fine needle aspiration track. Langenbecks Arch Surg. 2006;391:623–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Spinelli C, Bonadio AG, Berti P, Materazzi G, Miccoli P. Cutaneous spreading of parathyroid carcinoma after fine needle aspiration cytology. J Endocrinol Invest. 2000;23:255–7.PubMedGoogle Scholar
  8. 8.
    Shin JW, Ryu JS, Kim JS, Moon DH, Hong SM, Gong G, et al. Lesion localization in patients with hyperparathyroidism using double-phase Tc-99m MIBI parathyroid scintigraphy. Korean J Nucl Med. 1999;33:120–30.Google Scholar
  9. 9.
    Jeon TJ, Lee JD, Rhyu YH, Park JS, Jang HS. Comparison study of lesion localization in patients with primary and secondary hyperparathyroidism using double-phase Tc-99m sestamibi scintigraphy. Korean J Nucl Med. 1999;33:368–80.Google Scholar
  10. 10.
    Ruda JM, Hollenbeak CS, Stack Jr BC. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg. 2005;132:359–72.PubMedCrossRefGoogle Scholar
  11. 11.
    Lu G, Shih WJ, Xiu JY. Technetium-99 m MIBI uptake in recurrent parathyroid carcinoma and brown tumors. J Nucl Med. 1995;36:811–3.PubMedGoogle Scholar
  12. 12.
    Singhal T, Jacobs M, Mantil JC. Tc-99 m pertechnetate/sestamibi subtraction scan in a case of parathyroid carcinoma. Clin Nucl Med. 2008;33:196–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Clark P, Wooldridge T, Kleinpeter K, Perrier N, Lovato J, Morton K. Providing optimal preoperative localization for recurrent parathyroid carcinoma: a combined parathyroid scintigraphy and computed tomography approach. Clin Nucl Med. 2004;29:681–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Favia G, Lumachi F, Polistina F, D'Amico DF. Parathyroid carcinoma: sixteen new cases and suggestions for correct management. World J Surg. 1998;22:1225–30.PubMedCrossRefGoogle Scholar
  15. 15.
    Kebebew E, Arici C, Duh QY, Clark OH. Localization and reoperation results for persistent and recurrent parathyroid carcinoma. Arch Surg. 2001;136:878–85.PubMedCrossRefGoogle Scholar
  16. 16.
    Nakamura Y, Kataoka H, Sakoda T, Horie Y, Kitano H. Nonfunctional parathyroid carcinoma. Int J Clin Oncol. 2010;15:500–3.PubMedCrossRefGoogle Scholar
  17. 17.
    Hundahl SA, Fleming ID, Fremgen AM, Menck HR. Two hundred eighty-six cases of parathyroid carcinoma treated in the US between 1985–1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer. 1999;86:538–44.PubMedCrossRefGoogle Scholar
  18. 18.
    Cordeiro AC, Montenegro FL, Kulcsar MA, Dellanegra LA, Tavares MR, Michaluart Jr P, et al. Parathyroid carcinoma. Am J Surg. 1998;175:52–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Wynne AG, van Heerden J, Carney JA, Fitzpatrick LA. Parathyroid carcinoma: clinical and pathologic features in 43 patients. Med (Baltim). 1992;71:197–205.Google Scholar
  20. 20.
    Chen Q, Kaji H, Nomura R, Sowa H, Yamauchi M, Tsukamoto T, et al. Trial to predict malignancy of affected parathyroid glands in primary hyperparathyroidism. Endocr J. 2003;50:527–34.PubMedCrossRefGoogle Scholar
  21. 21.
    Carpentier A, Jeannotte S, Verreault J, Lefebvre B, Bisson G, Mongeau CJ, et al. Preoperative localization of parathyroid lesions in hyperparathyroidism: relationship between technetium-99m-MIBI uptake and oxyphil cell content. J Nucl Med. 1998;39:1441–4.PubMedGoogle Scholar
  22. 22.
    Sun SS, Shiau YC, Lin CC, Kao A, Lee CC. Correlation between P-glycoprotein (P-gp) expression in parathyroid and Tc-99m MIBI parathyroid image findings. Nucl Med Biol. 2001;28:929–33.PubMedCrossRefGoogle Scholar
  23. 23.
    Pons F, Torregrosa JV, Fuster D. Biological factors influencing parathyroid localization. Nucl Med Commun. 2003;24:121–4.PubMedCrossRefGoogle Scholar
  24. 24.
    Arbab AS, Koizumi K, Toyama K, Araki T. Uptake of technetium-99m-tetrofosmin, technetium-99m-MIBI and thallium-201 in tumor cell lines. J Nucl Med. 1996;37:1551–6.PubMedGoogle Scholar
  25. 25.
    Hassan IM, Sahweil A, Constantinides C, Mahmoud A, Nair M, Oamr YT, et al. Uptake and kinetics of Tc-99m hexakis 2-methoxy isobutyl isonitrile in benign and malignant lesions in the lungs. Clin Nucl Med. 1989;14:333–40.PubMedCrossRefGoogle Scholar
  26. 26.
    Petrovic NS, Grujicic D, Artiko VM, Sobic-Saranovic DP, Gajic MM, Jaksic E, et al. Investigation of blood perfusion and metabolic activity of brain tumours in adults by using 99m Tc-methoxyisobutylionitile. Nucl Med Commun. 2010;31:962–73.PubMedCrossRefGoogle Scholar
  27. 27.
    Ak I, Gulbas Z, Altinel F, Vardareli E. Tc-99m MIBI uptake and its relation to the proliferative potential of brain tumors. Clin Nucl Med. 2003;28:29–33.PubMedCrossRefGoogle Scholar

Copyright information

© Korean Society of Nuclear Medicine 2011

Authors and Affiliations

  • Miju Cheon
    • 1
  • Joon Young Choi
    • 1
    Email author
  • Jae-Hoon Chung
    • 2
  • Ji Young Lee
    • 1
  • Sook Kyung Cho
    • 1
  • Jang Yoo
    • 1
  • Soo Bin Park
    • 1
  • Kyung-Han Lee
    • 1
  • Byung-Tae Kim
    • 1
  1. 1.Department of Nuclear Medicine, Samsung Medical Center, SungkyunkwanUniversity School of MedicineSeoulKorea
  2. 2.Department of Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea

Personalised recommendations