Could Negative Tc-99m-Methoxyisobutylisonitrile (MIBI) Scintigraphy Obviate the Need for Surgery for Bethesda III and IV Thyroid Nodules?
| Autor: | Marianne Engels, Costanza Chiapponi, Anne M. Schultheis, Stella Armefti, Matthias Schmidt, Jasmin Mettler, Michael Faust |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Thyroid nodules
medicine.medical_specialty Adult patients medicine.diagnostic_test RD1-811 business.industry fine needle aspiration cytology diagnostic hemithyroidectomy Malignancy medicine.disease Scintigraphy University hospital 99mcTc MIBI scintigraphy 030218 nuclear medicine & medical imaging Surgery 03 medical and health sciences 0302 clinical medicine Bethesda III and IV Fine needle aspiration cytology 030220 oncology & carcinogenesis Cytology medicine Carcinoma business |
| Zdroj: | Surgeries, Vol 2, Iss 26, Pp 260-267 (2021) Surgeries Volume 2 Issue 3 Pages 26-267 |
| ISSN: | 2673-4095 |
| Popis: | In about 20% of all cases, the fine needle aspiration cytology (FNAC) results are equivocal, delivering the two common categories of indeterminate cytology, Bethesda III and IV. The observed rates of malignancy vary widely among institutions, with the urgent need for a more precise risk stratification. 99mcTc methoxyisobutylisonitrile scintigraphy (MIBI) is less expensive than molecular testing and has been shown to have a high negative predictive value. For this reason, the results of MIBI scintigraphy in adult patients with indeterminate FNAC were collected, and correlated with the final pathology reports of surgical specimens. Patients receiving FNAC, MIBI scintigraphy and surgery for sonographic suspicious hypofunctional thyroid nodules between 2015 and 2019 at the University Hospital of Cologne, Germany were identified. Sensitivity, specificity, positive predictive and negative predictive value of MIBI scintigraphy were calculated. Seventy-eight patients with sonographic suspicious hypofunctional thyroid nodules underwent surgery after interdisciplinary case discussion of both FNAC and MIBI results. In 49 (62.5%) cases, FNAC consisted of Bethesda III and IV results. In 39 (79.6%) of these cases, MIBI scintigraphy resulted in mismatch and intermediary results, but in only 4 (10.2%) of these cases was a carcinoma diagnosed. The negative predictive value of MIBI scintigraphy was 90–100%, respectively. Relying on the negative predictive value of MIBI match results might have obviated the need for surgery in 20.4% cases one papillary microcarcinoma, however, would have been missed. MIBI scintigraphy has an underused potential for improving the diagnostic precision of hypofunctional thyroid nodules. |
| Databáze: | OpenAIRE |
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