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Retention Index of Tc-99m MIBI Thyroid Scintigraphy, Ultrasonography, and Fine- Needle Aspiration Cytology in the Assessment of Thyroid Nodule Ivana D.

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Presentation on theme: "Retention Index of Tc-99m MIBI Thyroid Scintigraphy, Ultrasonography, and Fine- Needle Aspiration Cytology in the Assessment of Thyroid Nodule Ivana D."— Presentation transcript:

1 Retention Index of Tc-99m MIBI Thyroid Scintigraphy, Ultrasonography, and Fine- Needle Aspiration Cytology in the Assessment of Thyroid Nodule Ivana D. Mulyanto 1, Basuki Hidayat 1, Dimyati Achmad 2, A. Hussein S.Kartamihardja 1, Johan S. Masjhur 1 Department of Nuclear Medicine 1, Department of Oncological Surgery 2 Universitas Padjadjaran - Dr. Hasan Sadikin Hospital Bandung, Indonesia Ivana D. Mulyanto 1, Basuki Hidayat 1, Dimyati Achmad 2, A. Hussein S.Kartamihardja 1, Johan S. Masjhur 1 Department of Nuclear Medicine 1, Department of Oncological Surgery 2 Universitas Padjadjaran - Dr. Hasan Sadikin Hospital Bandung, Indonesia

2 BACKGROUND *Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer.Thyroid 2009;19:1167 – 8 Palpable 5% woman and 1% man US 19 – 67% PREVALENCEPREVALENCE

3 BACKGROUND 1.Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer.Thyroid 2009;19:1167–8 2.Schlumberger M., Pacini F. Thyroid tumor 3 th ed. Thyroid Nodule. Paris 2006:13–14 Thyroid nodule Thyroid cancer: 5 – 15% Benign lesion: 85– 95%

4 BACKGROUND Size, echogenicity, shape, margin, echostructure, calcification Operator dependent I-123, I-131, Tc-99m pertechnetate Cold nodule: 5-15% malignant FNAC 15-30% indeterminate result Non invasive preoperative diagnostic modalities

5 Tc-99m-hexakis-2-methoxyisobuthylisonitrile (Tc-99m MIBI) Negative potential membrane HIGH UPTAKE & RETENTION Malignant cell High number and activity of mitochondria Malignant thyroid nodule Rodrigues M, Chehne F, Kalinowska W, Berghammer P, Zielinski C, Sinzinger H. Uptake of 99m Tc-MIBI and 99m Tc-Tetrofosmin into malignant versus nonmalignant breast cell lines. J Nucl Med 2000; 41: Carew JS, Huang P. Mitochondrial defects in cancer. Mol Cancer 2002; 1: 9

6 OBJECTIVE This prospective study was designed to assess the significance of Tc-99m MIBI thyroid scintigraphy using retention index(RI) parameter, ultrasound(US), and fine-needle aspiration cytology(FNAC) in differetiating benign from malignant thyroid nodule.

7 Patients with palpable single thyroid nodule US Tc-99m MIBI thyroid scintigraphy FNACSurgery Inclusion criteria: cold nodule on Tc-99m pertechnetate thyroid scan; normal serum TSH and thyroid hormone level Kang score 2 benign Kang score >2 malignant Benign: coloid goitre, thyroiditis Indeterminate: follicular neoplasm Malignant: papillary thyroid ca Lobectomy, isthmolobectomy, or total thyroidectomy Dual phase acquisition with semiquantitative analysis

8 RESULT

9 RI of Tc-99m MIBI Histopathological finding p value MalignantBenign Mean(SD)1.04(0.50) 0.58(0.17)0.0015

10 RESULT Cut-off point: >0.58 Sensitivity : 87.5% Specificity : 70.6% PPV : 58.3% NPV : 92.3% Accuracy : 76% (95%CI: ; LR: 2.98)

11 RESULT Sensitivity 87.5%; specificity 52.9%; PPV 46.7%; NPV 90%; accuracy 64%

12 RESULT Sensitivity 62.5%; specificity 76.5%; PPV 55.5%; NPV 81.3%; accuracy 72% Indeterminate results (n=6): - 2 (33.3%) malignant (follicular thyroid ca) - 4 (66.6%) jinak (follicular adenoma) Tc-99m MIBI RI diagnosed 5 of 6 subjects (83.3%) with indeterminate result

13 RESULT Tc-99m MIBI Thyroid ScintigraphyUSFNAC Sensitivity87.5% 62.5% Specificity70.6%52.9%76.5% NPV92.3%90%81.3% PPV58.3%46.7%55.5% Accuracy76%64%72% Kappa Index

14 Discussion One subject with Tc-99m MIBI RI of 0.39 showed malignant histopathological finding. Five subjects with Tc-99m MIBI RI of 0.68 – 0.93 showed benign histopathological finding. Size Vascular supply Proliferation rate Size Vascular supply Proliferation rate ?

15 CONCLUSION RI of Tc-99m MIBI thyroid scintigraphy may be useful in the assessment of thyroid nodule, for it has high negative predictive value and agreement compared to histopathological result.

16 Thank You

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