Mustafa ÇAYCI, BARIŞ SEVİNÇ, Cevdet DURAN, Serra KAYAÇETİN, Ahmet OKUŞ, Şamil ECİRLİ, ÖMER KARAHAN

Malignite şüpheli veya foliküler tiroid lezyonlarında Tc99m sestamibi görüntüleme

Amaç: Bu çalışmamızda tiroid ince iğne aspirasyon biyopsisi (İİAB) sonucunda malignite açısından şüpheli veya foliküler lezyon saptanan nodüllerde maligniteyi tespit edebilmek için bir tümör ajanı olan Tc99m sestamibi kullanılabilirliğini inceledik. Yöntem: 24 hastada İİAB değerlendirmesinde malignite açısından şüpheli veya foliküler sitopatoloji saptandı ve bunlardan 13 tanesine Tc99m sestamibi ile görüntüleme yapıldıktan sonra tiroidektomi uygulandı. Sestamibi görüntüleme, İİAB ve histopatoloji sonuçları karşılaştırmalı olarak incelendi. Bulgular: Onikisi kadın, toplam 13 hasta çalımaya dahil edildi. Ortalama yaş 44,9±12,6 (29-77) idi. 10 (% 76,9) hastada malignite açısından şüpheli sitoloji, 3 (%23,1) hastada foliküler lezyon vardı. Histopatolojik incelemede 6 hastada papiller, 1 hastada foliküler, 1 hastada medüller, 4 hastada benign kistik guatr, 1 hastada ise lenfositik tiroidit saptandı. Medüller tiroid kanserli 1 olgu dışındaki tüm malign hastalarda (6 papiller ve 1 foliküler kanser) sestamibi tutulumu saptanırken, benign kistik guatrlı 4 olgudan birinde ve lenfositik tiroiditli 1 olguda sestamibi pozitif saptandı. Ortalama nodül çapı 26,9±20,1 mm idi (benign olanlarda 23,6±6.87 mm, malign olanlarda 29,28±26,45 mm, p>0.05). Sonuç: Tc99m sestamibi’nin sensitivite ve spesifitesi sırasıyla % 75 ve % 60, pozitif ve negatif prediktif değerler sırasıyla 0,75 ve 0,60 olarak bulundu. Bu konuda daha geniş hasta grupları içeren çalışmalara ihtiyaç olduğu kanaatine varıldı.

Tc99m sestamibi imaging in malignancy suspected or thyroid follicular lesions

Objective: In this study we evaluated the usefullness of Tc99msestamibi, a tumor agent, to detect malignancy for nodules reported as “SFM” and “ITFL”. Methods: Thirteen of 24 cases, reported as “SFM” or “ITFL” by FNAB, underwent bilateral total thyroidectomy after imaging by Tc99msestamibi. Then, Tc99msestamibi imaging, FNAB and hystopathologic results were compared. Results: There were only one male and the mean age was 44,9±12,6 (29-77). We detected “SFM” in 10 (76,9%) cases, and “TFL” in 3 (23,1%) cases. By hystopathologic investigation 6 papillary, 1 follicular, 1 medullary, 4 benign cystic goiter and 1 lymhocytic thyroiditis detected. There was MIBI uptake in all cases with malignancy, except one with medullary thyroid cancer (6 papillary and one follicular cancer). MIBI uptake was detected also in one of four cases with benign cystic gioter and one case with lynphocytic goiter. The mean nodule diameter was 26,9±20,1 mm (23,6±6.87 mm in benign cases, 29,28±26,45 mm in malignant cases, p>0.05). Conclusion: The sensitivity, specifity, pozitive and negative predictive value of of Tc99msestamibi were 75% and 60%, 0,75 ve 0,60, respectively. As conclusion, to determine the usefulness of Tc99msestamibi for detecting malignancy in nodules reported as “SFM” or “ITFL” by FNAB, more studies with larger populations should be performed.

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