Diagnostic accuracy of [99mTc]Tc-Sestamibi in the assessment of thyroid nodules
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Anna Yordanova1,*, Soha Mahjoob1,*, Philipp Lingohr2, Jörg Kalff2, Andreas Türler3, Holger Palmedo4, Hans-Jürgen Biersack1, Glen Kristiansen5, Jamshid Farahati6, Markus Essler1 and Hojjat Ahmadzadehfar1
1Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
2Department of Surgery, University Hospital Bonn, Bonn, Germany
3Department of General and Visceral Surgery, Johanniter-Krankenhaus Bonn, Bonn, Germany
4Institute of Radiology and Nuclear Medicine, PET-CT Center, Bonn, Germany
5Institute of Pathology, University Hospital Bonn, Bonn, Germany
6Department of Nuclear Medicine, Bethesda Hospital, Duisburg, Germany
*These authors have contributed equally to this work
Hojjat Ahmadzadehfar, email: firstname.lastname@example.org
Keywords: sestamibi, MIBI, thyroid nodules, thyroid cancer, cold nodule
Received: June 20, 2017 Accepted: September 16, 2017 Published: October 17, 2017
[99mTc]Tc-Sestamibi (MIBI) is an increasingly used tool for evaluation of thyroid nodules. However, there is a lack of evidence about the accuracy of this method in the European population. The aim of this study was to assess the utility of MIBI for the differentiation of thyroid nodules in a large cohort. 161 patients underwent MIBI, followed by a thyroidectomy. We used a dual phase MIBI protocol. Interpretation of the images included a scoring system from 0 (absent) to 3 (increased); this was to provide a scale for the uptake of the thyroid nodule in comparison to the paranodular tissue. Additionally, we evaluated the tracer uptake trend in late images compared to early images. We used the final histopathology as the reference standard. Scores 0-1 in early images, scores 0-2 in late images, and an absence of increasing uptake in the thyroid nodule in late images, showed the best predictive values to exclude malignancy, respectively (negative predictive value (NPV) 89%). Highest sensitivity (91%) for malignant nodules was evident in early images with a score 1-3. Highest specificity (91%) was obtained when the negative was defined as an absence of uptake-increase, in the late images. This study confirms that the most valuable feature of MIBI is the high NPV. Thus, with the appropriate interpretation method, high sensitivity and specificity, and moderate PPV can be obtained.
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