PDF herunterladen
Nuklearmedizin 2006; 45(05): 201-205
DOI: 10.1055/s-0038-1625220
Original Articles
Schattauer GmbH

Thallium-201 scan in evaluating thyroid nodules following equivocal fine-needle aspiration cytology

Thallium-201-Szintigraphie zur Beurteilung von Schilddrüsenknoten bei unklarer Feinnadelaspirationszytologie
J. K. Lee
1   Department of Nuclear Medicine, Chung-Shan Medical University Hospital, Taichung
,
R. S. Liu
2   Taipei Veterans General Hospital, Taipei
,
S. Y. Wu
3   Nuclear Medicine Service, Veterans’ Administration-University of California Irvine Healthcare System, Long Beach, CA, USA
,
W. S. Huang
4   Tri-Service General Hospital, Taipei, Taiwan
,
M. C. Chou
5   Department of Surgery, Chung-Shan Medical University Hospital, Taichung
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Received: 09. Januar 2006

in revised form: 24. April 2006

Publikationsdatum:
10. Januar 2018 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Summary:

The aim of this prospective study was to evaluate the usefulness of the thallium-201 (201Tl) thyroid scan in the detection of malignancy in cold thyroid nodules whose status was equivocal following palpation fine-needle aspiration cytology (FNAC). Patients, methods: Fifty-one patients with clinically palpable solitary cold thyroid nodules classified as non-diagnostic or suspicious following biopsy underwent 201Tl thyroid scans. Each scan was performed 15 min (early scan) and 3 h (delayed scan) after an intravenous administration of 74 MBq 201Tl. Thallium uptake in the nodules was visually assessed and scored on a three point scale, with a grade of three defining malignancy. All patients underwent surgery and the histopathology of nodule tissues were compared with results of the scans. Results: Fifty-one nodules were examined. Forty were benign and 11 were malignant. For early scans, the diagnostically relevant parameters were: sensitivity (100%), specificity (75%), and accuracy (80%). Corresponding findings for the delayed scan were: 91%, 98%, and 96%. Conclusion: The 201Tl scan is useful for detecting malignancy in cold thyroid nodules classified as nondiagnostic or suspicious lesions by FNAC.

Zusammenfassung:

In dieser prospektiven Studie sollte der Nutzen einer Thallium- 201-(201Tl)-Schilddrüsenszintigraphie zum Nachweis der Malignität von kalten Schilddrüsenknoten, deren Status nach Palpation und Feinnadelaspirationszytologie (FNAC) unklar war, untersucht werden. Patienten, Methodik: Bei 51 Patienten mit klinisch tastbaren, solitären kalten Schilddrüsenknoten, die einen unklaren oder malignitätsverdächtigen feinnadelzytologischen Befund aufwiesen, erfolgte eine 201Tl-Schilddrüsenszintigraphie. Es erfolgten jeweils 15 Minuten (Frühaufnahme) und drei Stunden (Spätaufnahme) nach intravenöser Verabreichung von 74 MBq 201Tl planare Szintigraphien. Die Thalliumaufnahme in die Knoten wurde visuell beurteilt und auf einer Dreipunkteskala bewertet; Grad 3 definierte dabei Malignität. Alle Patienten unterzogen sich einer Operation, der histopathologische Befund des Knotengewebes wurde mit den Ergebnissen der Szintigraphie verglichen. Ergebnisse: 51 Knoten wurden untersucht. 40 waren gutartig, 11 waren bösartig. Bei den Frühszintigraphien waren die diagnostisch relevanten Parameter: Sensitivität (100%), Spezifität (75%) und Genauigkeit (80%). Die entsprechenden Ergebnisse für das Spätszintigramm lagen bei 91%, 98% und 96%. Schlussfolgerung: Die 201Tl-Szintigraphie eignet sich zum Nachweis der Malignität von kalten Schilddrüsenknoten, die anhand der FNAC als nicht diagnostizierbare oder als verdächtige Läsionen klassifiziert werden.

Key words:

Thallium-201 scan - fine-needle aspiration cytology - cold thyroid nodule - malignancy

Schlüsselwörter:

Thallium-201-Szintigraphie - Feinnadelaspirationszytologie - kalter Schilddrüsenknoten - Malignität
 

  • References

  • 1 Alexander EK, Heering JP, Benson CB. et al. Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab 2002; 87: 4924-7.
    CrossrefPubMedSuche in Google Scholar
  • 2 Ando A, Ando I, Katayama M. et al. Biodistributions of 201Tl in tumor bearing animals and inflammatory lesion induced animals. Eur J Nucl Med 1987; 12: 567-72.
    CrossrefPubMedSuche in Google Scholar
  • 3 Bae KT, Piwnica-Worms D. Pharmacokinetic modeling of multidrug resistance P-glycoprotein transporter of gamma-emitting substances. Q J Nucl Med 1997; 41: 101-10.
    PubMedSuche in Google Scholar
  • 4 Bakhos R, Selvaggi SM, DeJong S. et al. Fineneedle aspiration of the thyroid: rate and causes of cytohistopathologic discordance. Diagn Cytopathol 2000; 23: 233-7.
    CrossrefPubMedSuche in Google Scholar
  • 5 Ballinger JR, Sheldon KM, Boxen I. et al. Differences between accumulation of 99mTc-MIBI and 201Tl-thallous chloride in tumor cells: role of P-glycoprotein. Q J Nucl Med 1995; 39: 122-8.
    PubMedSuche in Google Scholar
  • 6 Baloch ZW, Fleisher S, LiVolsi VA. et al. Diagnosis of „follicular neoplasm“: a gray zone in thyroid fine-needle aspiration cytology. Diagn Cytopathol 2002; 26: 41-4.
    CrossrefPubMedSuche in Google Scholar
  • 7 Bleichrodt RP, Vermey A, Piers DA. et al. Early and delayed thallium 201 imaging. Diagnosis of patients with cold thyroid nodules. Cancer 1987; 60: 2621-3.
    CrossrefPubMedSuche in Google Scholar
  • 8 Brooks AD, Shaha AR, DuMornay W. et al. Role of fine needle aspiration biopsy and frozen section analysis in the surgical management of thyroid tumors. Ann Surg Oncol 2001; 8: 92-100.
    CrossrefPubMedSuche in Google Scholar
  • 9 Chow LS, Gharib H, Goellner JR. et al. Nondiagnostic thyroid fine-needle aspiration cytology: management dilemmas. Thyroid 2001; 11: 1147-51.
    CrossrefPubMedSuche in Google Scholar
  • 10 Cooper DS, Doherty GM, Haugen B. et al. Management guidelines for patients with thyroid nodulies and differentiated thyroid cancer. Thyroid 2006; 16: 1-33.
    CrossrefPubMedSuche in Google Scholar
  • 11 Demirel K, Kapucu Ö, Yücel C. et al. A comparison of radionuclide thyroid angiography, 99mTc- MIBI scintigraphy and power Doppler ultrasonography in the differentiatial diagnosis pf solitary cold thyroid nodules. Eur J Nucl Med Mol Imaging 2003; 30: 642-50.
    CrossrefPubMedSuche in Google Scholar
  • 12 Derebek E, Biberoglu S, Kut O. et al. Early and delayed thallium-201 scintigraphy in thyroid nodules: the relationship between early thallium-201 uptake and perfusion. Eur J Nucl Med 1996; 23: 504-10.
    CrossrefPubMedSuche in Google Scholar
  • 13 El-Desouki M. 201Tl thyroid imaging in differentiating benign from malignant thyroid nodules. Clin Nucl Med 1991; 16: 425-30.
    CrossrefPubMedSuche in Google Scholar
  • 14 Erdil TY, Ozker K, Kabasakal L. et al. Correlation of technetium-99m MIBI and thallium-201 retention in solitary cold thyroid nodules with postoperative histopathology. Eur J Nucl Med 2000; 27: 713-20.
    CrossrefPubMedSuche in Google Scholar
  • 15 Feld S. AACE Clinical Practice Guidelines for the diagnosis and management of thyroid nodule. Endocr Pract 1996; 2: 80-4.
    Suche in Google Scholar
  • 16 Frable WJ. Aspiration cytology. In: Keebler CM, Somrak TM. (eds). The Manual of Cytotechnology. Hong Kong: ASCP Press; 1993: 240-5.
    Suche in Google Scholar
  • 17 Gharib H, Goellner JR, Johnson DA. Fine-needle aspiration cytology of the thyroid. A 12-year experience with 11,000 biopsies. Clin Lab Med 1993; 13: 699-709.
    CrossrefPubMedSuche in Google Scholar
  • 18 Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med 1993; 118: 282-9.
    CrossrefPubMedSuche in Google Scholar
  • 19 Gharib H. Fine-needle aspiration biopsy of thyroid nodules: advantages, limitations, and effect. Mayo Clin Proc 1994; 69: 44-9.
    CrossrefPubMedSuche in Google Scholar
  • 20 Greaves TS, Olvera M, Florentine BD. et al. Follicular lesions of thyroid: a 5-year fine-needle aspiration experience. Cancer 2000; 90: 335-41.
    CrossrefPubMedSuche in Google Scholar
  • 21 Hardoff R, Baron E, Sheinfeld M. Early and late lesion-to-non-lesion ratio of thallium-201 chloride uptake in the evaluation of „cold“ thyroid nodules. J Nucl Med 1991; 32: 1873-6.
    PubMedSuche in Google Scholar
  • 22 Hegedus L. The thyroid nodule. N Engl J Med 2004; 351: 1764-71.
    CrossrefPubMedSuche in Google Scholar
  • 23 Hegedus L. Thyroid ultrasound. Endocrinol Metab Clin North Am 2001; 30: 339-60.
    CrossrefPubMedSuche in Google Scholar
  • 24 Henze E, Roth J, Boerer H. et al. Diagnostic value of early and delayed 201Tl thyroid scintigraphy in the evaluation of cold nodules for malignancy. Eur J Nucl Med 1986; 11: 413-6.
    PubMedSuche in Google Scholar
  • 25 Huang SM, Lee CH. et al. Characteristics of thyroidectomy in Taiwan. J Formos Med Assoc 2005; 104: 6-11.
    PubMedSuche in Google Scholar
  • 26 Hurtado-López LM, Arellano-Montaño S, Migdalia E. et al. Combined use of fine-needle aspiration biopsy, MIBI scans and frozen section biopsy offers the best diagnostic accuracy in the assessment of the hypofunctioning solitary thyroid nodule. Eur J Nucl Med Imaging 2004; 31: 1273-9.
    PubMedSuche in Google Scholar
  • 27 Kim ES, Kim TY, Koh JM. et al. Completion thyroidectomy in patients with thyroid cancer who initially underwent unilateral operation. Clin Endocrinol (Oxf) 2004; 61: 145-8.
    CrossrefPubMedSuche in Google Scholar
  • 28 Klain M, Maurea S, Cuocolo A. et al. Technetium- 99m tetrofosmin imaging in thyroid diseases: comparison with 99mTc-pertechnetate, thallium- 201, and 99mTc-methoxyisonitrile scans. Eur J Nucl Med Mol Imaging 1996; 23: 1568-74.
    CrossrefPubMedSuche in Google Scholar
  • 29 Klemenz B, Wiehler H, Kaiser KP. Value of color coded Doppler sonography in the differential diagnosis of nodular thyroid gland changes. Nuklearmedizin 1997; 36: 245-9.
    Thieme ConnectPubMedSuche in Google Scholar
  • 30 Kume N, Suga K, Nishigauchi K. et al. Relationship between thallium-201 uptake and tumour proliferative ability in thyroid nodules. Eur J Nucl Med 1996; 23: 376-82.
    CrossrefPubMedSuche in Google Scholar
  • 31 Lind P, Gallowitsch HJ, Langsteger W. et al. Technetium- 99m-tetrofosmin whole body scintigraphy in the follow-up of differentiated thyroid cancer. J Nucl Med 1997; 38: 348-52.
    PubMedSuche in Google Scholar
  • 32 Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med 1993; 328: 553-9.
    CrossrefPubMedSuche in Google Scholar
  • 33 Nakahara H, Noguchi S, Murakami N. et al. Technetium- 99m-sestamibi scintigraphy compared with thallium-201 in evaluation of thyroid tumors. J Nucl Med 1996; 37: 901-4.
    PubMedSuche in Google Scholar
  • 34 Nakamura K, Nishiguchi I, Takagi Y. et al. Accumulation mechanism of 201Tl-K-contents and Na, K-ATPase activities of tissue. Radioisotopes 1983; 32: 626-8.
    CrossrefPubMedSuche in Google Scholar
  • 35 Ochi H, Sawa H, Fukuda T. et al. Thallium- 201-chloride thyroid scintigraphy to evaluate benign and/or malignant nodules: usefulness of the delayed scan. Cancer 1982; 50: 236-40.
    CrossrefPubMedSuche in Google Scholar
  • 36 Okumura Y, Takeda Y, Sato S. et al. Comparison of differential diagnostic capabilities of 201Tl scintigraphy and fine-needle aspiration of thyroid nodules. J Nucl Med 1999; 40: 1971-7.
    PubMedSuche in Google Scholar
  • 37 Ravetto C, Colombo L, Dottorini ME. Usefulness of fine-needle aspiration in the diagnosis of thyroid carcinoma: a retrospective study in 37,895 patients. Cancer 2000; 90: 357-63.
    CrossrefPubMedSuche in Google Scholar
  • 38 Sathekge MM, Mageza RB, Muthuphei MN. et al. Evaluation of thyroid nodules with technetium- 99m MIBI and technetium-99m pertechnetate. Head Neck 2001; 23: 305-10.
    CrossrefPubMedSuche in Google Scholar
  • 39 Sessler MJ, Geck P, Maul FD. et al. New aspects of cellular thallium uptake: Tl+-Na+-2Cl (-)-cotransport is the central mechanism of ion uptake. Nuklearmedizin 1986; 25: 24-7.
    Thieme ConnectPubMedSuche in Google Scholar
  • 40 Silver RJ, Parangi S. Management of thyroid incidentalomas. Surg Clin North Am 2004; 84: 907-19.
    CrossrefPubMedSuche in Google Scholar
  • 41 Siperstein AE, Clark OH. Surgical therapy. In: The Thyroid: a Fundamental and Clinical Text. Braverman LE, Utiger RD. (eds). 8th ed. New York: Lippincott; 2000: 898-903.
    Suche in Google Scholar
  • 42 Tennvall J, Palmer J, Biorklund A. et al. Kinetics of 201Tl uptake in adenomas and well-differentiated carcinomas of the thyroid. A double isotope investigation with 99mTc and 201Tl. Acta Radiol Oncol 1984; 23: 55-9.
    CrossrefPubMedSuche in Google Scholar
  • 43 The National Health Insurance Statistics. Bureau of National Health Insurance, Taiwan. 2001 No. 82001-11.
    PubMedSuche in Google Scholar
  • 44 Tyler DS, Shaha AR, Udelsman RA. et al. Thyroid cancer: 1999 update. Ann Surg Oncol 2000; 7: 376-98.
    CrossrefPubMedSuche in Google Scholar
  • 45 Waxman AD. Thallium-201 and technetium-99m methoxyisobutyl isonitrile (MIBI) in nuclear oncoloby. In: Sandler MP, Coleman RE, Patton JA. et al. (eds). Diagnostic nuclear medicine. 4th ed. New York: Lippincott; 2003: 931-50.
    Suche in Google Scholar