sodium-pertechnetate-tc-99m and Adenoma--Pleomorphic

Topics: Abscess; Adenolymphoma; Adenoma, Pleomorphic; Cysts; Humans; Parotitis; Radionuclide Imaging; Salivary Duct Calculi; Salivary Gland Diseases; Salivary Gland Neoplasms; Salivary Glands; Sialadenitis; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Xerostomia

Warthin's tumors and oncocytomas show exceptionally good (99m)TcO4(-) (Tc) accumulation images in Tc scintigraphy. However, the mechanism of Tc accumulation in these tumors remains unclear. Sodium-iodide symporter (NIS) is a plasma membrane protein expressed in the thyroid, lactating breast, stomach and salivary glands; it facilitates uptake of I(-) and Tc. We hypothesized that Warthin's tumor cells and oncocytomas may also express NIS, which would promote uptake of Tc. We examined NIS localization and the mechanism of Tc accumulation in various salivary gland tissues.. Immunohistological localization of NIS was performed for 19 tumors from 18 patients who underwent preoperative Tc scintigraphy. Expression of mRNA for NIS in the normal salivary gland, Warthin's tumors and pleomorphic adenomas was analyzed by real-time PCR.. In normal salivary glands, striated duct cells were strongly immunostained by anti-NIS antibodies. In Warthin's tumors, eosinophilic epithelial cells exhibited positive immunostaining, but their staining was varied among the cases. Furthermore, all Tc-positive specimens were NIS-positive, and all Tc-negative specimens were NIS-negative. Real-time PCR showed that NIS mRNA expression was detectable in normal salivary glands and Warthin's tumor cells. The expression was significantly higher in normal salivary glands compared with Warthin's tumor cells and pleomorphic adenoma.. Tc-positive salivary glands expressed NIS. Our findings suggest that Tc accumulation in Warthin's tumors and oncocytomas is due to poorer Tc excretory function compared with normal salivary gland tissues, in addition to active uptake of (99m)TcO4(-) via NIS.

Topics: Adenolymphoma; Adenoma; Adenoma, Oxyphilic; Adenoma, Pleomorphic; Carcinoma, Acinar Cell; Carcinoma, Mucoepidermoid; Humans; Immunohistochemistry; Lymphoma; Radionuclide Imaging; Radiopharmaceuticals; RNA, Messenger; Salivary Gland Neoplasms; Salivary Glands; Sodium Pertechnetate Tc 99m; Symporters

This study investigated the diagnostic accuracy of 99mTc-pertechnetate scintigraphy with lemon juice stimulation for evaluating parotid gland Warthin's tumor.. Technetium-99m-pertechnetate scintigraphy with intraoral lemon juice stimulation was used to evaluate a total of 68 parotid gland lesions clinically suspected of being Warthin's tumor in 62 patients. Twenty-three of the 68 lesions were subsequently histologically confirmed to be Warthin's tumor, whereas the remaining 45 lesions were histologically diagnosed as being other lesions.. Technetium-99m-pertechnetate scintigraphy with lemon juice stimulation correctly diagnosed 18 of 23 Warthin's tumors as being Warthin's tumor but was unable to diagnose the other five Warthin's tumors. Further, scintigraphy correctly diagnosed 41 of 45 non-Warthin's tumors as being non-Warthin's tumor but misdiagnosed other four non-Warthin's tumors as Warthin's tumor. Thus, the sensitivity of scintigraphy for diagnosing Warthin's tumor was found to be 78%, its specificity 91% and its accuracy 87%. On the basis of prestimulation images alone, however, the sensitivity was estimated to be 65%, its specificity 93% and its accuracy 84%.. For evaluating Warthin's tumor, the sensitivity of 99mTc-pertechnetate scintigraphy was relatively low, although the specificity was sufficiently high. Lemon juice stimulation improved the sensitivity markedly but decreased the specificity slightly. Thus, 99mTc-pertechnetate scintigraphy with lemon juice stimulation should be carefully performed for diagnosis of Warthin's tumor.

Topics: Adenolymphoma; Adenoma, Pleomorphic; Citrus; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Parotid Neoplasms; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

The usefulness of combined Tc-99m and Ga-67 scans in diagnosing salivary gland disorders was evaluated in a total of 31 patients. Out of 6 patients with Warthin's tumor, 4 showed a typical pattern of high-activity in the gland with retention of Tc-99m, but without an affinity for Ga-67. Out of 9 patients with pleomorphic adenoma, 8 showed a "cold" area in the tumor by Tc-99m and 5 of the 9 patients had accumulated Ga-67. Five of 6 patients with malignant tumor showed an affinity for Ga-67. Nine of 10 patients with sialadenitis showed diffuse uptake of both Tc-99m and Ga-67 in the involved gland. Combined Tc-99m and Ga-67 imaging was useful in detecting the cases of Warthin's tumor and sialadenitis (90% sensitivity and 89% specificity for sialadenitis), but the study had limitations in differentiating malignant tumors from benign tumors (66% sensitivity and 84% specificity). However, Ga-67 imaging showed a 91% negative predictive value. A negative scan could almost rule out the possibility of malignant disease of the salivary gland.

Topics: Adenocarcinoma; Adenolymphoma; Adenoma, Pleomorphic; Adolescent; Adult; Aged; Aged, 80 and over; Child; Citrates; Citric Acid; Female; Humans; Male; Middle Aged; Mixed Tumor, Malignant; Parotid Neoplasms; Radionuclide Imaging; Salivary Gland Diseases; Sialadenitis; Sodium Pertechnetate Tc 99m; Submandibular Gland Neoplasms

The clinical efficacy of salivary gland scintigraphy was evaluated in 32 histologically proven cases. In benign tumors, except Warthin's tumor, 16 of the 20 cases (80%) appeared as cold lesions. All six cases of Warthin's tumor appeared as hot lesions. In malignant tumors, one case each of mucoepidermoid carcinoma, adenopapillary carcinoma, and adenoid-cystic carcinoma were shown as cold lesions, while squamous cell carcinoma and malignant mixed tumor were delineated as a defect image (no uptake of radionuclide). On stimulation with ascorbic acid, retention of radionuclide within the tumor was noted only in Warthin's tumors, but it was noted at the periphery of the tumors in 21 of the 24 cases (87.5%), which might be due to inflammation and/or compression of the gland by the tumors. Salivary gland scintigraphy provided useful information for the evaluation of the site of the tumor and the function of the salivary gland.

Topics: Adenolymphoma; Adenoma, Pleomorphic; Adult; Aged; Carcinoma, Squamous Cell; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Salivary Gland Neoplasms; Sodium Pertechnetate Tc 99m; Technetium