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Una panoramica sull’attuale utilizzo in Europa della scintigrafia con 99mTc-MIBI nei noduli tiroidei a citologia indeterminata

An overview on current European use of qualitative and semiquantitative 99mTc-MIBI scintigraphy in cytologically indeterminate thyroid nodule

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L'Endocrinologo Aims and scope

Sommario

La stratificazione preoperatoria del rischio di malignità dei noduli tiroidei è un momento diagnostico fondamentale per ridurre il numero di procedure chirurgiche non necessarie. Nei noduli ipofunzionanti (noduli freddi), specialmente quelli con citologia indeterminata, l’imaging scintigrafico molecolare ottenuto dopo la somministrazione di 99mTc-Metossi-Isobutil-Isonitrile (99mTc-MIBI) può essere un utile strumento diagnostico per escludere la natura maligna. Infatti, il mancato accumulo del 99mTc-MIBI nel nodulo ipofunzionante è indice di benignità (valore predittivo negativo fino al 100%). Al contrario, nei pazienti con iperaccumulo nodulare del 99mTc-MIBI, le prestazioni diagnostiche dell’imaging scintigrafico possono essere notevolmente incrementate utilizzando l’analisi semiquantitativa mediante il calcolo del wash-out index (WOind). Infatti, se il wash-out del tracciante è \(\geq{-}19\)% (tra le immagini precoci e quelle tardive), la natura maligna del nodulo può essere fortemente sospettata (specificità, sensibilità, valore predittivo negativo e positivo complessivi possono arrivare fino al 100%).

Abstract

Preoperative malignancy risk stratification of thyroid nodules still plays an essential role in order to avoid unnecessary surgery. In hypofunctioning nodules, especially those with indeterminate cytology, scintigraphic imaging with 99mTc-Methoxy-isobutyl-isonitrile (MIBI) can be a useful diagnostic tool to rule out malignancy. As a matter of fact, 99mTc-MIBI scintigraphy is indicative of benign growth in case of absent tracer uptake in the nodule (negative predictive value up to 100%). By contrast, in patients showing abnormal nodular MIBI uptake, the diagnostic performance of the method can be significantly increased by semiquantitative approach using the washout index analysis (WOind). Hence, if the tracer washout is ≥-19% (between the early and delayed images), nodular malignancy can be suspected (overall specificity, sensitivity, negative and positive predictive value may reach up to 100%).

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital Frankfurt, Frankfurt, Germany

    Justus Baumgarten

  2. Department and Institute of Nuclear Medicine, Hospital Bayreuth, Bayreuth, Germany

    Simone Agnes Schenke

  3. Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany

    Simone Agnes Schenke

  4. Unità di Medicina Nucleare, Azienda Ospedaliera Universitaria Policlinico “Gaetano Martino”, Messina, Messina, Italia

    Antonino Raffa & Alfredo Campennì

  5. Center of Nuclear Medicine and Molecular Imaging Essen, Essen, Germany

    Verena Ruhlmann

  6. Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali, Università di Messina, Messina, Italia

    Alfredo Campennì

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Correspondence to Alfredo Campennì.

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Gli autori Justus Baumgarten, Simone Agnes Schenke, Antonino Raffa, Verena Ruhlmann e Alfredo Campennì dichiarano di non avere conflitti di interesse.

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Baumgarten, J., Schenke, S.A., Raffa, A. et al. Una panoramica sull’attuale utilizzo in Europa della scintigrafia con 99mTc-MIBI nei noduli tiroidei a citologia indeterminata. L'Endocrinologo 24, 519–525 (2023). https://doi.org/10.1007/s40619-023-01354-y

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