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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Complementary role of parathormone washout test to 99mTc-MIBI parathyroid scinti...
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Vol. 37. Issue 4.
Pages 205-210 (July - August 2018)
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Vol. 37. Issue 4.
Pages 205-210 (July - August 2018)
Original Article
DOI: 10.1016/j.remnie.2018.01.001
Complementary role of parathormone washout test to 99mTc-MIBI parathyroid scintigraphy and histopathologic analysis of cell types in parathyroid adenomas
Gammagrafía paratiroidea con 99mTc-MIBI: valor complementario de la paratohormona en el aspirado y análisis histopatológico de los tipos de células en los adenomas paratiroideos
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Semra Incea,
Corresponding author
drsemra@gmail.com

Corresponding author.
, Ozdes Emera, Salih Devecib, Kursat Okuyucua, Engin Alagoza, Huseyin Sana, Aslı Ayana, Ozgur Karacalioglub, Cem Haymanac, Bengul Gunalpa, Nuri Arslana
a University of Health Sciences, Gulhane Training and Research Hospital, Department of Nuclear Medicine, Ankara, Turkey
b University of Health Sciences, Gulhane Training and Research Hospital, Department of Pathology, Ankara, Turkey
c University of Health Sciences, Gulhane Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
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Tables (2)
Table 1. The evaluated continuous and categorical variables of patients in Group A and Group B with their significance values.
Table 2. Statistical significance according to PWT result, serum PTH level and lesion size between PS (+) and PS (N/E) parathyroid adenomas with presence of clear cell.
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Abstract
Objective

Parathyroid scintigraphy (PS) can be negative or equivocal (N/E) in a considerable number of cases with highly suspicious clinical findings and biochemical results for parathyroid adenoma (PA). The aims of this study were to investigate the complementary role of parathormone washout test (PWT) to PS in patients with primary hyperparathyroidism (PHPT) and evaluate histopathologic aspects of PAs in comparison with PS results.

Material and methods

Thirty-eight patients with PHPT referred for PS were included in the study. Seventeen patients had both scintigraphic and ultrasonographic findings concordant with PA (Group A). Twenty-one patients having N/E PS, but suspected lesions for PA on ultrasonography (US) formed Group B. PWT was performed for all patients and they underwent the surgical intervention. An adenoma was removed in all patients and the histopathologic cell characteristics were established.

Results

The tumor size on US was larger in those patients whose adenomas were seen on the PS (p<0.001). The percentages of chief (or principal), oxyphilic and clear cells in PAs were not statistically different between the groups. Serum parathormone level and PWT were not statistically significant between Group A and Group B (p=0.095 and p=0.04, respectively).

Conclusion

Although there is not a definitive threshold value, the sensitivity of PS increases with lesion size. While chief cell and oxyphilic cell content of PAs tend to deplete in N/E PS, clear cell rate increases substantially. Combining PS with both US and PWT increases the sensitivity of detection and localization of PAs.

Keywords:
Chief cell
Clear cell
Oxyphilic cell
PTH in FNA
Parathyroid scintigraphy
Resumen
Objetivo

La gammagrafía paratiroidea (GP) puede ser negativa o equívoca (N/E) en un número considerable de casos con alta sospecha clínica y bioquímica de adenoma de paratiroides (AP). Los objetivos de este estudio fueron investigar el papel complementario de la determinación de paratohormona en punción con aguja fina (PTH en PAAF) con la GP en pacientes con hiperparatiroidismo primario (HPTP) y evaluar los aspectos histopatológicos de los AP en comparación con los resultados de GP.

Material y métodos

Fueron incluidos en el estudio 38 pacientes con HPTP remitidos para realizar GP. 17 pacientes tuvieron resultados gammagráficos y ecográficos concordantes con AP (Grupo A). 21 pacientes con GP N/E pero sospecha de AP en la ecografía formaron el Grupo B. Se realizó PTH en PAAF en todos los pacientes y todos fueron operados. Se extirpó un adenoma en cada uno de ellos y en todos los casos se establecieron las características histopatológicas.

Resultados

El tamaño del tumor en la ecografía fue mayor en aquellos pacientes cuyos adenomas se vieron en la GP (p<0,001). Los porcentajes de células principales, oxífilas y claras en AP no fueron estadísticamente diferentes entre los grupos. El nivel de paratohormona sérica y PTH en PAAF no fueron estadísticamente significativos entre los grupos A y B (p=0,095 y p=0,04, respectivamente).

Conclusión

Aunque no existe un valor umbral definitivo, la sensibilidad de la GP aumenta con el tamaño de la lesión. Mientras que el contenido de células principales y oxífilas tiende a reducirse en los AP con GP N/E EP, la tasa de células claras aumenta sustancialmente. La combinación de GP con la US y la PTH en PAAF aumenta la sensibilidad de detección y localización de los AP.

Palabras clave:
Células principales
Células claras
Células oxífilas
PTH en PAAF
Gammagrafía paratiroidea

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