sodium-pertechnetate-tc-99m and Carcinoma

The aim of this study is to call attention to the role that radioactive iodine ((131)I) and stapes surgery may play in causing hyposalivation.. The manner in which (131)I and stapes surgery can cause salivary damage was reviewed. A case report is presented to illustrate the involved pathophysiology.. The case report clearly shows the significant injury to the parotid glands caused by the (131)I. However, subjective symptoms of oral dryness only developed after injury to the chorda tympani nerve (CTN) during stapes surgery.. The loss of function of both parotid glands after (131)I therapy for thyroid cancer was initially compensated by the secretions of the more radiation-resistant submandibular and sublingual salivary glands (SMSG/SLSG). Damage to the CTN's secretory fibers in one SMSG/SLSG complex led to subjective oral dryness by accentuating an existing objective hyposalivation.

Topics: Carcinoma; Carcinoma, Papillary; Chorda Tympani Nerve; Female; Humans; Iodine Radioisotopes; Lymphatic Metastasis; Middle Aged; Otosclerosis; Parotid Gland; Radiopharmaceuticals; Radiotherapy, Adjuvant; Sodium Pertechnetate Tc 99m; Stapes Surgery; Thyroid Cancer, Papillary; Thyroid Neoplasms; Xerostomia

Primary hyperparathyroidism and concomitant thyroid cancer is a rare and complicated setting for diagnostic imaging.. The authors report the accidental finding of primary hyperparathyroidism in a patient with rapid enlargement of a thyroid nodule and the results of a literature review.. Tl-201-Tc-99m subtraction scintigraphy correctly revealed the malignant nature of a large cold thyroid nodule and mediastinal parathyroid hyperplasia. In contrast, high-resolution ultrasound indicated a retrothyroidal hyperplastic parathyroid gland. Surgery followed the findings of the preoperative ultrasound and intraoperative biopsy, yet hyperparathyroid disease persisted. Repeated scintigraphy confirmed an ectopic parathyroid gland, which was resected from a paraesophageal location. Subsequently, hormone and calcium levels returned to normal and remained normal during a follow-up period of 3 years. A literature review revealed a prevalence of approximately 3% of nonmedullary thyroid cancer, which was found in patients operated on for primary hyperparathyroidism. Previous neck irradiation, especially in childhood, appears to be a risk factor for the development of both nonmedullary thyroid carcinoma and for primary hyperparathyroid disease.. This case illustrates the need for clinical awareness of concomitant hyperparathyroidism and nonmedullary thyroid cancer and is substantiated with published case reviews. The preoperative scintigraphic localization of hyperfunctioning parathyroid tissue, although not advised as a routine procedure, may provide diagnostic information in addition to high-resolution ultrasound and intraoperative biopsy. In addition, scintigraphy can be useful even in the technically difficult setting of concomitant thyroid cancer.

Topics: Adenoma; Adult; Carcinoma; Humans; Hyperparathyroidism; Male; Neoplasms, Multiple Primary; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Subtraction Technique; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Thyroid Neoplasms

Parathyroid carcinoma is a rare clinical entity accounting for only 4 per cent of all cases of parathyroid neoplasia. Nonfunctioning parathyroid carcinoma is even rarer. Previously, virtually all patients with these lesions were treated for a nonspecific neck mass. However, in the present case, a preoperative diagnosis of nonfunctioning parathyroid carcinoma was made based on the technetium pertechnetate/thallium 201 subtraction scan. The authors report on the 14th case of nonfunctioning parathyroid carcinoma, a review of the literature, and guidelines for the preoperative and operative evaluation of neck masses suspected to be parathyroid carcinoma.

Topics: Adult; Carcinoma; Humans; Male; Parathyroid Neoplasms; Parathyroidectomy; Prognosis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroidectomy

Topics: Adenolymphoma; Adenoma; Carcinoma; Gallium Radioisotopes; Humans; Radionuclide Imaging; Saliva; Salivary Gland Diseases; Salivary Gland Fistula; Salivary Gland Neoplasms; Sialadenitis; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Technetium; Tuberculosis, Oral

Measurement of serum thyroglobulin (Tg) levels and I-131 whole body scintigraphy (WBS) are used in the follow-up of patients with differentiated thyroid cancer (DTC). This study was designed to evaluate the significance of persistent I-131 uptake in the thyroid bed in patients with DTC following surgery and/or radioactive iodine ablation. Tc-99m thyroid scintigraphy (TS) and I-131 thyroid uptake (IU) were also performed to determine their clinical impact on patient management.. Sixty-two non-metastatic patients (14 men, 48 women) with a mean age of 44 years (range: 16-75) who had undergone surgical thyroidectomy for DTC were evaluated prospectively. All patients had undergone technetium and iodine scintigraphy (IS). Although serum Tg levels were measured in all patients, IU was available in 36.. Tg values were in the range of 0.2-24 ng/ml (median: 0.2 ng/ml) when patients were in the hypothyroid state. I-131 WBS detected residual tissue in the neck in 30 patients (48%); however TS was positive in only 12 (19%). I-131 uptake in the thyroid bed ranged from 0 to 14% (median: 0.1%). Twelve of 13 patients with positive IS and negative TS had uptake values < or = 0.3% (p < 0.00001). When IU values were < or = 0.3%, 54% of our patients did not have any uptake in the thyroid bed on TS or IS, whereas when IU was > 0.3%, 80% of patients had neck uptake on both TS and IS (p < 0.00001).. The results of this study demonstrate that the concordance of IS and TS depends on the IU level after suspension of replacement therapy. Measurements of IU and TS are of considerable value in evaluating patient response to therapy and will substantially reduce the need for repetitive radioiodine scans and unnecessary treatment doses in patients with undetectable Tg values.

Topics: Adolescent; Adult; Aged; Carcinoma; Female; Follow-Up Studies; Humans; Iodine Radioisotopes; Male; Middle Aged; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroglobulin; Thyroid Neoplasms; Treatment Outcome

Although radioiodines are widely used to localize metastatic differentiated thyroid cancer (DTC), TcO4 also can be used because it is a substrate for the sodium-iodide symporter protein. The use of TcO4 has advantages over radioiodine, namely, easy availability, dispensability of iodine restriction, and early imaging time. However, its low sensitivity precludes its practical application. Scintigraphic detectability of DTC using sodium-iodide symporter substrates is related to the serum TSH levels. Here, I report a case with multiple metastatic lesions of DTC that were detected upon TSH-stimulated TcO4 scintigraphy, but not with non-TSH-stimulated scintigraphy using the same tracer.

Topics: Carcinoma; Humans; Iodine Radioisotopes; Male; Middle Aged; Positron-Emission Tomography; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Symporters; Thyroid Neoplasms; Thyrotropin

The aim of this study was to design a method of radionuclide for imaging and therapy of nasopharyngeal carcinoma (NPC) using the transferred human sodium/iodide symporter (hNIS) gene.. A stable NPC cell line expressing hNIS was established (CNE-2-hNIS). After 131I treatment, we detected proliferation and apoptosis of NPC cells, both in vitro and vivo. In vivo, the radioactivity of different organs of nude mice was counted and (99m)Tc imaging using SPECT was performed. The apparent diffusion coefficient (ADC) value changes of tumor xenografts were observed by diffusion-weighted magnetic resonance imaging (DW-MRI) within 6-24 days of 131I treatment. The correlation of ADC changes with apoptosis and proliferation was investigated. Post-treatment expression levels of P53, Bax, Bcl-2, Caspase-3, and Survivin proteins were detected by western blotting.. 131I uptake was higher in CNE-2-hNIS than in CNE-2 cells. The proliferation and apoptosis rate decreased and increased respectively both in vitro and vivo in the experimental group after 131I treatment. The experimental group tumors accumulated (99m)Tc in vivo, leading to a good visualization by SPECT. DW-MRI showed that ADC values increased in the experimental group 6 days after treatment, while ADC values were positively and negatively correlated with the apoptotic and Ki-67 proliferation indices, respectively. After treatment, CNE-2-hNIS cells up-regulated the expression of P53 and Survivin proteins and activated Caspase-3, and down-regulated the expression of Bcl-2 proteins.. The radionuclide imaging and therapy technique for NPC hNIS-transfected cell lines can provide a new therapy strategy for monitoring and treatment of NPC.

Topics: Animals; Apoptosis; Carcinoma; Cell Line, Tumor; Cell Proliferation; Diffusion Magnetic Resonance Imaging; Gene Expression Regulation, Neoplastic; Humans; Iodine Radioisotopes; Mice; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Neoplasm Transplantation; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Symporters; Transfection

Topics: Biopsy, Fine-Needle; Carcinoma; Carcinoma, Papillary; Female; Humans; Middle Aged; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Cancer, Papillary; Thyroid Neoplasms; Thyroid Nodule

The purpose of this study was to evaluate the relationship between postsurgical neck (⁹⁹m) technetium ((⁹⁹m) Tc)-pertechnetate uptake and the rate of successful remnant ablation after radioiodine treatment in patients with differentiated thyroid carcinoma (DTC).. Retrospectively enrolled were 232 patients with DTC who underwent total thyroidectomy and fixed activity ablation with 3.7 GBq ¹³¹I. The (⁹⁹m) Tc scans were performed on all patients before ¹³¹I administration. Thyroid ablation was assessed after 6 to 12 months by thyroid-stimulating hormone (TSH)-stimulated ¹³¹I-WBS and thyroglobulin measurement. The rate of successful ablation, occurrence of radioiodine-induced thyroiditis, and length of hospitalization were correlated with the (⁹⁹m) Tc-pertechnetate scintigraphy results.. A (⁹⁹m) Tc uptake was significantly lower in ablated versus nonablated patients (p < .001). High (⁹⁹m) Tc-pertechnetate uptake, especially greater than 1.4%, predicted a high-risk of unsuccessful ablation. Higher (⁹⁹m) Tc-pertechnetate uptake was also related to prolonged hospitalization and the occurrence of radioiodine-induced thyroiditis.. The (⁹⁹m) Tc-pertechnetate scintigraphy is a simple and feasible tool to evaluate thyroid remnants and to predict radioiodine ablation results in patients with DTC.

Topics: Administration, Oral; Adolescent; Adult; Aged; Carcinoma; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroglobulin; Thyroid Gland; Thyroid Neoplasms; Thyroidectomy; Thyrotropin; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Young Adult

Topics: Aged; Bone Diseases, Metabolic; Calcium; Carcinoma; Humans; Male; Neoplasm Recurrence, Local; Parathyroid Hormone; Parathyroid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi

The aim of this study was to determine the prevalence of trapping-only nodules of the thyroid gland. The study was prospectively performed in patients bearing hot or warm thyroid nodules at pertechnetate scan in the presence of circulating thyrotropin (TSH) within the normal range. The study was restricted to these patients because nodules that suppress TSH are certainly autonomous. In 140 patients showing hot or warm nodules at 30-minute pertechnetate scintigraphy, and normal TSH levels, radioiodine scintigraphy was performed at 24 hours. The trapping-only pattern, i.e., the presence of a cold nodule in late radioiodine scintigraphy was observed in seven patients (5%). Five had benign thyroid nodules, one follicular carcinoma, and one extrathyroid metastases of papillary-follicular carcinoma. Despite controversy on this issue, trapping-only nodules of thyroid should be searched because they have risk of malignancy and must be differentiated from autonomous adenomas at the compensated stage. The search may be limited to patients with normal serum TSH.

Topics: Adenocarcinoma, Follicular; Adult; Aged; Carcinoma; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Neoplasm Metastasis; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule; Thyrotropin

The diagnostic value of scintigraphy using a dual tracer and high-resolution neck ecotomography in the preoperative localisation of parathyroid enlargements was evaluated in a group of consecutive patients suffering from primary hyperparathyroidism (HPT) who were uniformly studied and subsequently operated by the same surgical team.. Scintigraphic imaging and high-resolution neck ecotomography were carried out in a single session on 143 patients. Scintigraphic imaging was performed using a dual tracer, 99mTc-pertechnetate/99mTc-MIBI), modified by the addition of potassium perchlorate (KCL04) to achieve a rapid washout of 99mTc04 from the thyroid and, consequently, to achieve good quality and rapid MIBI images. In a limited number of patients (21 cases) SPECT was also performed. Limited surgery was planned in patients with evidence of single parathyroid lesions and with normal thyroid parameters, in the form of either unilateral or with mini-invasive surgery (91 cases). Patients with eco-scintigraphic evidence of multiglandular parathyroid pathology or the coexistence of a nodular thyroid goitre, or in patients suffering from MEN or familial HPT, or lastly those with negative eco-scintigraphic results under-went more extensive surgery with bilateral exploration of the neck (52 cases). A single parathyroid lesion was diagnosed during surgery in 90 out of 91 patients undergoing planned unilateral or mini-invasive exploration of the neck. Therefore, in our experience, the predictive value of preoperative imaging as a mean of identifying single parathyroid lesions was 98.9% with a clear impact on the choice of conservative surgery. After the removal of the parathyroid to which preoperative imaging referred, it was only necessary in one patient to extend surgical exploration to the other side of the neck to remove another enlarged parathyroid owing to persistent high PTH.. The sensitivity of scintigraphy and high-resolution neck ecotomography in pa-tients with a single adenoma was 94% and 83.7% respectively, whereas it was 76.9% and 64.5% respectively in the group of patients with multiglandular pathology. It is worth underlining that in all 31 patients with associated nodular thyroid pathology, the evaluation of thyroid scintigraphic imaging using 99mTc04 and high-resolution neck ecotomography enabled the preoperative diagnosis of thyroid pathology, therefore guiding the surgeon towards more extensive surgery. SPECT enabled the parathyroid adenoma to be correctly localised in a deep site in 5 patients, in the neck in 3 cases and at the mediastinum in 2 patients, providing additional data that helped the surgeon to plan surgery.. In conclusion, in our experience: a) an integrated diagnostic approach based on scintigraphy 99mTc04 & KCLO4/MIBI and high-resolution neck ecotomography was an extremely accurate mean of identifying patients with single parathyroid lesions before surgery, enabling them to undergo limited surgery, b) scintigraphy with a dual tracer might be the elective methods for studying patients with HPT because it allows the contemporary diagnosis of possible thyroid diseases. This aspect is extremely important in geographical areas with a high predominance of nodular thyroid pathology, c) SPECT scintigraphic analysis may be useful in some patients with suspected parathyroid adenoma localised in a deep seat, allowing a more precise identification of the latter and better surgical planning.

Topics: Adenoma; Adult; Aged; Carcinoma; Female; Follow-Up Studies; Humans; Hyperparathyroidism; Male; Mediastinum; Middle Aged; Multiple Endocrine Neoplasia Type 1; Neck; Parathyroid Neoplasms; Parathyroidectomy; Perchlorates; Potassium Compounds; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon; Ultrasonography

The contribution of nuclear-medical mapping using 99mTc-MIBI (MIBI) and the use of an intraoperative probe in primary hyperparathyroidism (I degrees HPT) surgery was evaluated prospectively in a series of patients undergoing parathyroidectomy.. Fifty-four patients, who were operated between May 1999 and July 2000, under-went a systematic preoperative evaluation using scintigraphy with a dual tracer 99Tc04/MIBI and image subtraction, and high-resolution neck ecotomography. Surgery was performed using a mini-invasive technique through an incision measuring 2-2.5 cm at the base of the neck in 46 patients; the other 8 patients underwent open surgery with bilateral exploration of the neck. MIBI was injected intravenously in the operating theatre following the induction of anesthesia and after 32 minutes on average, radioactivity was measured using a manual gamma probe. Radioactivity was also counted intraoperatively at the tip of the lung contralateral to the pathological gland, a parameter used as the base activity (B), in the presumed seat of the hyperfunctioning parathyroid (P), in correspondence with healthy thyroid tissue (T) and any associated thyroid nodes (N). Radioactivity was also recorded at the level of the empty parathyroid compartment after removal of the corresponding gland, and on the parathyroid removed ex vivo .. The ratio between the three main parameters, T/B, P/B and P/T was respectively 1.6 (range=1.5 - 1.8), 2.7 (range=1.6-4.0) and 1.6 (range=1.1-2.8). In 4 cases (7.4%), the small size of the parathyroids, adjacent to thyroid nodes, meant that the parathyroid measurement of MIBI was smaller than the thyroid measurement. The histological finding was consistent with: single parathyroid adenoma in 49 cases, multiple adenomas in 3 cases, parathyroid carcinoma in 2 cases. Rapid intraoperative PTH normalised in all patients.. The significant difference in radioactivity levels recorded in the patients, showed that the technique is useful to the surgeon as a means of intraoperative assay for hyperfunctioning parathyroids, even if it cannot obviously replace experience or the value of preoperative scientigraphic and ecotomographic imaging.

Topics: Adenoma; Adult; Aged; Carcinoma; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Neoplasms, Multiple Primary; Parathyroid Neoplasms; Parathyroidectomy; Prospective Studies; Radiology, Interventional; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Ultrasonography

The actuarial risk for developing benign or malignant thyroid disease following radiation therapy (RT) is controversial, but may be as high as 50% at 20 years. An effective screening modality should be specific but not overly sensitive, a limitation of ultrasound. We questioned whether Technetium-99 m pertechnetate ((99m)Tc TcO(4)(-)) scanning could detect clinically significant disease in ostensibly disease-free cancer survivors.. Eligibility criteria included an interval of at least 5 years after RT to the cervical region, a thyroid gland that was normal to palpation, euthyroid status determined by clinical examination, free T4 and TSH. The 34 patients scanned included 16 children (<18 years old) and 18 adults at the time of RT, 16 females and 18 males. The mean age at RT was 20 years (range, 2.1-50.3 years), and the mean age at (99m)Tc TcO(4)-scanning was 33 years (range, 13.6-58 years), providing a mean interval of 13 years (range, 5.3-26.6 years). The mean RT dose to the thyroid was 36.4 Gy (range, 19.5-52.5). Thyroid scanning was performed with a 5 mCi dose of (99m)Tc TcO(4)(-) obtaining flow, immediate and delayed static, and pinhole collimator images.. Seven patients (21.6%) had abnormal scans, and the percentage was higher among children (25%) and females (25%) compared to adults (16.7%) and males (16.7%), respectively. Two of 34 patients (5.9%) were discovered to have a thyroid cancer; histopathologies were papillary and follicular carcinoma.. In this population of clinically normal cancer survivors who had been irradiated to the cervical region, subclinical thyroid disease, of potential clinical significance, was detected by (99m)Tc TcO(4)(-) in about 20%. Children may be more commonly affected. Although the cost effectiveness of screening will require a larger sample number, we propose a surveillance schema for this patient population.

Topics: Adolescent; Adult; Carcinoma; Cerebellar Neoplasms; Child; Child, Preschool; Female; Hodgkin Disease; Humans; Male; Medulloblastoma; Neoplasms, Radiation-Induced; Neoplasms, Second Primary; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms

The anti-carcinoembryonic antigen (CEA) antibody, BW 431/26 (Scintimun CEA, Behringwerke, Marburg, Germany ) labeled with technetium pertechnectate (99mTc), is an intact immunoglobulin G1, monoclonal antibody that has been used to image colorectal cancer. Planar and SPECT images of chest, abdomen and pelvis were performed at 10 minutes, 4-6 and 18-24 hours after the intravenous antibody injection. 44 patients were studied and the pathological antibody concentration localization by radioimmunoimaging (RI) were correlated with surgical, clinical and other imaging modality findings to validate the RI. The RI was positive in 29 patients and negative in the other 15 patients. The CEA and CA 19.9 were elevated in the serum of some patients with primary tumors or recurrence. The HAMA were determined in all the patients before and after the RI.

Topics: Adult; Aged; Animals; Antibodies, Monoclonal; Antigens, Neoplasm; CA-19-9 Antigen; Carcinoembryonic Antigen; Carcinoma; Colonic Neoplasms; Colorectal Neoplasms; Evaluation Studies as Topic; Female; Humans; Male; Mice; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasm, Residual; Predictive Value of Tests; Radioimmunodetection; Rectal Neoplasms; Sigmoid Neoplasms; Sodium Pertechnetate Tc 99m; Species Specificity; Tomography, Emission-Computed, Single-Photon

In primary hyperparathyroidism (pHPT), parathyroidectomy is the treatment of choice, but anatomic variations of ectopic glands may cause surgical failure. Reliable preoperative noninvasive localization procedures would have a positive impact on the operative time and increase recovery rate. We retrospectively evaluated 186 patients with pHPT who were studied before successful parathyroidectomy by double tracer scintigraphy (99mTc-pertechnetate+201TI chloride or 99mTc-pertechnetate +99mTc-sestamibi, 160 patients), ultrasonography (148 patients) and computerized tomography (CT) scan (92 patients). During bilateral neck exploration, 159 (85.5%) single adenomas, 6 (3.2%) parathyroid carcinomas, and 3 (1.6%) double adenomas were found. Moreover, 18 (9.7%) patients had diffuse chief cells parathyroid hyperplasia. Removed parathyroid glands were in ectopic sites in 41 (22.0%) cases, mainly localized in the upper mediastinum or behind the esophagus. The overall sensitivity was 83.5 and 85.2% for 99mTc-pertechnetate+201TI chloride and 99mTc-pertechnetate+99mTc-sestamibi scintigraphy respectively, 80.4% for CT scan and 81.1% for ultrasonography. In patients with ectopic glands, sensitivity was 81.2, 79.5, 73.3 and 81.6% respectively. In 36 out of 41 patients with ectopic glands in whom the removed parathyroids were correctly localized, mean operative time was 95 min, and in 5 patients without preoperative localization it was 260 min. In conclusion, in pHPT, preoperative localization of an enlarged parathyroid is helpful, especially in ectopic adenomas and in anatomic variations in location, and it has been proved to reduce operative time and morbidity rate.

Topics: Adenoma; Adult; Aged; Aged, 80 and over; Carcinoma; Evaluation Studies as Topic; Female; Humans; Hyperparathyroidism; Intraoperative Period; Male; Middle Aged; Parathyroid Neoplasms; Parathyroidectomy; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thallium; Thallium Radioisotopes; Tomography, X-Ray Computed; Ultrasonography

Topics: Adenolymphoma; Carcinoma; Diagnosis, Differential; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Salivary Glands; Sodium Pertechnetate Tc 99m; Tomography, X-Ray Computed

After the intravenous administration of a radiolabeled somatostatin analogue (octreotide), normal thyroid and neoplastic and nonneoplastic thyroid lesions can be visualized. The authors present the cases of two patients who underwent somatostatin receptor scintigraphy (SSRS) using In-111 pentetreotide: one for the study of suspected paraneoplastic ACTH hypersecretion, and the other for a restaging of breast carcinoma with neuroendocrine features. In both patients, SSRS revealed increased uptake in the thyroid, corresponding to "cold" nodules on Tc-99m pertechnetate imaging. Cytologic and histologic examinations showed the typical features of thyroid goiters without lymphocytic infiltration.

Topics: Adenoma; Adrenocorticotropic Hormone; Biopsy, Needle; Breast Neoplasms; Carcinoma; Female; Goiter, Nodular; Humans; Indium Radioisotopes; Injections, Intravenous; Middle Aged; Neoplasm Staging; Neuroendocrine Tumors; Paraneoplastic Syndromes; Pituitary Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Somatostatin; Sodium Pertechnetate Tc 99m; Somatostatin; Thyroid Gland; Thyroid Nodule

Solitary hyperfunctioning nodules of the thyroid gland are usually viewed as benign. They may present with autonomous euthyroidism but are of concern for potential progression to hyperthyroidism. Various methods of treatment are worthy of consideration.. Forty-five patients with solitary hot thyroid nodules verified by radioisotope scintiscanning were selected for treatment. Thirty-one underwent surgery, usually partial thyroidectomy. Eight euthyroid patients received no treatment, 5 underwent therapy with radioactive iodine (RAI), and 1 received thyroid suppression treatment. The cases were assessed retrospectively.. Thyroidectomy patients had no morbidity, were well, and showed 1 Hürthle cell tumor and 5 coincidental small malignancies associated with benign hot nodules, including a contralateral cancer. Untreated patients showed continuance of good health, but nodules persisted and 1 Graves' orbititis occurred. The RAI-treated patients had persistent nodularity, improved function, and 1 case of hyperparathyroidism. Thyroid feeding only caused iatrogenic toxicity and was discontinued.. There are various techniques for managing the hot nodule. Nonsurgical methods may be effective, but can result in persistent nodularity and iatrogenic sequelae. Excision had no morbidity in this series and was effective in providing immediate relief of problems present and potential.

Topics: Adenocarcinoma; Adenocarcinoma, Follicular; Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma; Disease Progression; Female; Follow-Up Studies; Graves Disease; Humans; Hyperparathyroidism; Hyperthyroidism; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule; Thyroidectomy; Thyroxine; Triiodothyronine

This report describes a rare case of parathyroid carcinoma associated with an adenoma. Nuclear imaging provided the most specific information about localization of the primary carcinoma and cervical metastasis, but failed to demonstrate evidence of a parathyroid adenoma. This could be explained by a partial inhibition of hormonal biosynthesis due to the high level of circulating parathormone produced by the carcinoma.

Topics: Adenoma; Carcinoma; Humans; Hyperparathyroidism; Male; Middle Aged; Neoplasms, Multiple Primary; Parathyroid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes

Topics: Adult; Carcinoma; Deoxyglucose; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Parathyroid Neoplasms; Preoperative Care; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Tomography, Emission-Computed; Tomography, X-Ray Computed

Thyroid gland scintigraphy was performed in 29 dogs with histologically confirmed thyroid tumors. Twenty dogs were female, and 9 were male. Median age was 10 years. Of the 29 dogs, 21 were initially examined because of cervical swelling or a cervical mass. Of the 29 tumors, 24 were thyroid adenocarcinomas, 1 was a C-cell carcinoma, 3 were undifferentiated carcinomas, and 1 was a thyroid adenoma. Serum triiodothyronine and thyroxine concentrations were determined in 25 dogs. Sixteen dogs were euthyroid, 6 were hyperthyroid, and 3 were hypothyroid. In all 29 dogs, results of scintigraphy were abnormal. The most common scintigraphic appearance (13 dogs) was a unilateral thyroid mass with increased radionuclide uptake, relative to that of the parotid salivary glands. There did not appear to be an association between distribution of radionuclide uptake and histologic diagnosis, although there appeared to be an association between distribution of uptake and histologic degree of capsular invasion. All 4 dogs with extensive capsular invasion and 11 of 17 dogs with limited capsular invasion had poorly circumscribed, heterogeneous uptake of pertechnetate by the tumor. All hyperthyroid dogs had intense uptake, and 5 of 6 hyperthyroid dogs had well-circumscribed, homogenous uptake. Scintigraphy did not appear to offer any additional benefit, compared with thoracic radiography, for detection of pulmonary metastases.

Topics: Adenocarcinoma; Adenoma; Animals; Carcinoma; Carcinoma, Medullary; Dog Diseases; Dogs; Female; Lung Neoplasms; Male; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroxine; Triiodothyronine

Over a period of twelve years we have performed 793 parasternal lymphoscintigrams with microcolloids in 272 patients with unilateral carcinoma of the breast. In 173 patients we were able to follow their course with an average of four examinations and an average period of observation of 48 months. The parasternal lymph nodes could be identified in 59.6% (on the side of the tumour in 55.1%, on the contralateral side in 64.2%). Expressed as an index with maximal value of 1, the (non-)demonstration constant was 0.79 (side of the tumour 0.78, opposite side 0.80). Comparison of the total scans with the initial findings showed general loss of scintigraphic uptake which, however, is not reflected during individual ICR localisation. Patients with the highest prevalence of parasternal metastases showed atypical uptake. There was no change in uptake in those patients who subsequently developed distant metastases.

Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Carcinoma; Colloids; Female; Follow-Up Studies; Humans; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Neoplasm Staging; Radionuclide Imaging; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Sternum; Time Factors

Primary or relapsing hyperparathyroidism should not be considered a result only of benign conditions like adenoma or hyperplasia (primary or secondary). Parathyroid carcinoma is often the real cause but, because of its rarity, sometimes it is either overlooked or misdiagnosed. Even histologic classification can be erroneous. Distant metastases or ectopic location of the tumors are another potential cause of misdiagnosis, especially when management is decided without the help of diagnostic imaging modalities, particularly those related to the functional aspect of the tumors or their metastases, such as the Tl-201/Tc-99m subtraction scan and the Tl-201 whole body scan.

Topics: Adult; Carcinoma; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium Radioisotopes

Sixty eight women, operated for ovarian carcinoma, were studied by monoclonal antibodies anti-CA-125 labeled with 131I. 99m-Tc was used for the scintigraphy. Ninety-one metastases were discovered as 73 of them were established surgically. 52/61 were confirmed in the pelvis, 19/24 in the abdominal cavity and 3/6 in the liver. Higher precision of immunoscintigraphy was found in the diagnosis of liver metastasis, when it was compared with echographic and computed tomographic examinations.

Topics: Adult; Antibodies, Monoclonal; Antigens, Tumor-Associated, Carbohydrate; Carcinoma; Evaluation Studies as Topic; Female; Humans; Iodine Radioisotopes; Lymphatic Metastasis; Middle Aged; Ovarian Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Aggregated Albumin; Tomography, X-Ray Computed; Ultrasonography

During a ten-year period from 1977 to 1986 75 thyroid malignancies were found. The most common carcinomas were papillary (43%), follicular (39%) and anaplastic forms (7%). All 66 thyroids imaged with 99mTc-pertechnetate showed at least one cold nodule. Two or more cold nodules were seen in 52% of thyroids. In 63 of 66 cases the carcinoma was located in a cold nodule. The location of the carcinoma was not possible to find out accurately in the remaining three cases. 40% of frozen sections obtained at surgery showed benign and 60% malignant finding. Fine needle aspiration biopsy showed benign finding in 10 of 20 patients, suspicious for malignancy in 6 and malignant finding only in 4 cases.

Topics: Adult; Aged; Biopsy, Needle; Carcinoma; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

During a 10-year period, 63 patients with thyroid malignancies were imaged with 99mTc-pertechnetate (99mTc) and 9 of them also underwent imaging with 131I. To evaluate 99mTc in the detection of thyroid carcinoma, the scans were blindly analyzed and compared with the reports of surgeons and pathologists. The carcinomas were located in hypoactive nodules in 60 cases, there were cold nodules in the three remaining thyroids, but accurate localization of the carcinomas was not possible, however, it seemed that only one of these could have been situated either in a hot or a cold nodule. The 99mTc and 131I images were almost the same. The most common carcinomas were papillary (46%) and follicular (38%) forms. More than one hypoactive nodule was detected in 48% of patients, two or more carcinoma nodules were noted in 17%, and multinodular goitre in 29% of patients. Our study confirms the usefulness of 99mTc in carcinoma detection, we suggest that reimaging of all the functioning nodules on the 99mTc scan with radioiodine, as recommended by many authors, is neither necessary nor justifiable.

Topics: Adenocarcinoma; Carcinoma; Carcinoma, Papillary; Female; Humans; Iodine Radioisotopes; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Parathyroid carcinoma is a slow growing tumor, and the patients most often die from complications to the hypercalcemia. Therefore, any attempt should be made to remove local recurrence and metastasis surgically, as medical treatment is disappointing. A case treated with extensive vascular surgery to the neck is reported.

Topics: Adult; Carcinoma; Carotid Arteries; Humans; Hypercalcemia; Male; Neoplasm Recurrence, Local; Parathyroid Hormone; Parathyroid Neoplasms; Reoperation; Sodium Pertechnetate Tc 99m

Thyroid tumors were diagnosed in 26 dogs between 1977 and 1984. A total of 23 of the 26 tumors were carcinomas, and 3, detected as incidental findings at necropsy, were adenomas. The median patient age was 9.5 years. Dogs of the Beagle breed were affected most commonly (5 dogs). The most common physical abnormalities in carcinoma patients were cervical swelling, dyspnea, and coughing. A total of 25 of 26 dogs were clinically euthyroid. Aspiration cytology provided diagnostic information in 8 of 17 cases. In dogs with thyroid carcinoma, a cervical soft tissue lesion was identified consistently by use of radiography and scintigraphy with sodium pertechnetate. Pulmonary metastases were detected radiographically in 8 of 21 dogs with thyroid carcinoma. Thoracic nuclear imaging confirmed the radiographic findings in 11 of 14 dogs. Surgical excision of the thyroid mass was the primary treatment for 17 dogs with carcinoma. Eight dogs died within 2 years (median, 7 months) of surgery because of primary tumor regrowth or metastases. Four dogs were alive at a range of 3 to 48 months after surgery, and 4 dogs died from unrelated causes. Necropsy of 7 dogs with thyroid carcinoma revealed neoplastic infiltration of the cervical blood vessels and pulmonary metastases in each dog. The most common histologic patterns of thyroid carcinoma were solid or compact cellular (11 dogs) and mixed solid-follicular tumors (8 dogs). Dogs with a solid carcinoma had a median survival time of 10.5 months (6 dogs), and dogs with a mixed solid-follicular tumor had a median survival time of 8 months (3 dogs).

Topics: Adenoma; Animals; Carcinoma; Dog Diseases; Dogs; Female; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Topics: Adenoma; Adolescent; Adult; Aged; Carcinoma; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Thyroid Neoplasms

99mTc-O4 and/or 67Ga-citrate scintigraphies were preoperatively applied to 13 cases of parotid mucoepidermoid tumor. The resected specimens were histopathologically subdivided into three types: well (6 cases), moderately (one case), and poorly differentiated (6 cases). As the other parotid neoplasms except adenolymphoma and oxyphilic adenoma, all poorly differentiated tumors showed focal defect image in 99mTc-O4 scintiscanning (4/4). They indicated a focal hot image in 67Ga-citrate scanning at a high rate (4/6). Otherwise, well differentiated tumors were scarcely pointed out in cold image and were usually indicated as a symmetrical image (5/6) in 99mTc-O4 scanning. None of them showed a focal hot image in 67Ga-citrate scanning, but two cases indicated diffuse increased uptake and another case showed a focal defect image. The clinical prognosis of mucoepidermoid tumors is extremely correlated to the degree of cell differentiation in our prospective study. For that reason, the therapeutic method should be carefully selected in the tumors suspected of low grade malignancy. Our study suggests that RI (99mTc-O4 and 67Ga-citrate) scintigraphy is helpful in evaluating the malignancy grade of mucoepidermoid tumors.

Topics: Adolescent; Adult; Aged; Carcinoma; Gallium Radioisotopes; Humans; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Only 15% to 25% of cold nodules on conventional static thyroid scans are malignant. Radionuclide angiography of the thyroid and conventional static scans using sodium pertechnetate Tc 99m were performed on 114 patients who underwent thyroid surgery within a five-year period. The combined use of radionuclide angiography and conventional static scans increased the specificity for the diagnosis of thyroid carcinoma from 42% to 79% over static scans alone. The incidence of carcinoma in solitary cold nodules in our population was increased from 26% on static scans to 60% if the lesion was hypervascular on radionuclide angiography. Eighty-seven percent of hypervascular solitary cold nodules were neoplasms (carcinomas and adenomas). Hypervascularity as demonstrated by radionuclide angiography is predictive of thyroid neoplasia. The finding of a hypervascular, solitary cold nodule makes a recommendation for surgery predictive and reasonable.

Topics: Adenocarcinoma; Adenoma; Carcinoma; Carcinoma, Papillary; Diagnosis, Differential; Graves Disease; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Thyroid Neoplasms

We correlated scintigraphy and histological findings in 40 cases of nodular goiter in which two or more kinds of scintigraphy were performed preoperatively. 201Tl scintigraphy for imaging thyroid carcinoma showed a diagnostic agreement of 80% for thyroid lesions and 82% for metastatic lesions in the cervical lymph nodes. These agreements were higher than with 99mTc-bleomycin scintigraphy. Thus, 201Tl scan can be used to evaluate 'cold' thyroid nodules and to visualize metastatic lesions. 201Tl scan was also found valuable as a diagnostic measure for local recurrence of thyroid carcinoma. However, there were a few false-positive and false-negative results.

Topics: Adenoma; Adult; Carcinoma; Female; Head and Neck Neoplasms; Humans; Middle Aged; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium; Thyroid Neoplasms

Conventional antibodies against prostatic acid phosphatase, labeled with iodine-131, have been administered to patients with prostatic carcinoma for the external scintigraphic imaging of tumors containing prostatic acid phosphatase (radioimmunodetection). The method has been found to be safe and reliable for imaging of primary tumors and non-bone metastases, even differentiating between lung tumors of prostatic and pulmonary origin.

Topics: Acid Phosphatase; Animals; Antibodies; Bone Neoplasms; Carcinoma; Goats; Humans; Iodine Radioisotopes; Isotope Labeling; Lung Neoplasms; Male; Prostate; Prostatic Neoplasms; Rabbits; Radionuclide Imaging; Serum Albumin; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Aggregated Albumin

Radioimmunodetection of colorectal cancer was evaluated in 51 patients by injecting 131I-labeled goat antibody immunoglobulin G against carcinoembryonic antigen and performing total-body photoscans with a gamma scintillation camera 24 and 48 h later. The scintigrams were then processed by computer to subtract the images of the 99mTc-serum albumin and pertechnetate administered, which reflect background and nontarget radioactivity, from the 131I-antibody scans. The results indicate that radioimmunodetection is a safe and a potentially clinically useful cancer detection method, which in this study demonstrated primary colorectal carcinomas in 10 of 12 (83%) of the patients evaluated preoperatively and between 87% (46 of 53) and 92% (49 of 53) of known metastatic tumor sites. Thus, the method's overall sensitivity (true-positive rate) was 86%-91% on a tumor-site basis. A false-negative rate of between 9% and 14% and a false-positive rate of less than 4% were found. In 11 of the 51 patients evaluated, tumor sites were detected that were not found by other clinical methods of cancer detection. These sites of tumor were then confirmed later, as much as 40 wk after radioimmunodetection was performed. It is concluded that in colorectal cancer patients, the current method of carcinoembryonic antigen radioimmunodetection can (a) contribute to the preoperative clinical staging of the patients, (b) assist in the postoperative evaluation of tumor recurrence or spread, (c) complement other methods used to assess tumor response to therapy, (d) support the indication of a rising carcinoembryonic antigen titer (when other methods cannot detect tumor) for second-look surgery, and (e) confirm the findings of other detection measures that are less tumor-specific.

Topics: Aged; Animals; Carcinoembryonic Antigen; Carcinoma; Colonic Neoplasms; False Negative Reactions; False Positive Reactions; Goats; Humans; Immunoglobulin G; Iodine Radioisotopes; Middle Aged; Radioimmunoassay; Rectal Neoplasms; Serum Albumin; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Aggregated Albumin

Findings on pre-operative thyroid scintiscans in 29 patients with medullary carcinoma of the thyroid were compared with results of palpation and pathological findings. Six patients had a normal uptake of 131I or 99mTc in tumours 1.5--8 cm in diameter. When compared with 111 pre-operative scintiscans in other thyroid carcinomas, the frequency of normal uptake in medullary carcinomas was high, 19% versus 0--6%. Gallium-67 scintiscans were performed in nine patients. Six patients had extensive tumours, but accumulation of 67Ga appeared in only one patient.

Topics: Adult; Aged; Carcinoma; Female; Gallium Radioisotopes; Humans; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Neoplasms

Topics: Carcinoma; Female; Humans; Middle Aged; Radionuclide Imaging; Salivary Gland Neoplasms; Sodium Pertechnetate Tc 99m; Sublingual Gland; Technetium