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Clinicopathological variables that correlate with sestamibi positivity in uniglandular parathyroid disease: a retrospective analysis of 378 parathyroid adenomas

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Abstract

Purpose

Technetium-99 m sestamibi parathyroid scintigraphy (MIBI scan) has been used to localize abnormal glands in patients with primary hyperparathyroidism to guide parathyroidectomy. This series aimed to identify the biochemical and histopathological correlates of MIBI scan findings in patients with parathyroid adenoma.

Methods

A total of 378 patients with histologically and biochemically proven parathyroid adenoma were included. The results of MIBI scan, histopathological (gland volume and weight, oxyphil cell ratio), biochemical (blood and 24 h urine calcium, creatinine, glomerular filtration rate, parathormone, alkaline phosphate, and vitamin D3) variables were recorded. A positive uptake on the MIBI scan referred to a localized adenoma. Among histological variables, a cutoff of 30% was applied to define parathyroid adenomas with low (≤ 30%) and high (> 30%) oxyphil cell content. Statistical analyses were performed to assess the relationship among variables.

Results

MIBI scan localized the adenoma in 306 patients. Parathyroid gland volume and weight, and oxyphil ratio were significantly higher in the MIBI scan-positive group. Among the biochemical variables, only PTH was found to be significantly increased in the MIBI scan-positive group. Binary logistic regression models identified statistically significant cutoffs for the gland volume (1700 mm3), gland weight (1.3 g) and PTH levels (170 pg/mL) that can be used to predict the MIBI scan positivity.

Conclusion

In addition to PTH levels, this series underscored the impact of cellular composition along with the parathyroid gland volume and weight, both of which correlate with sestamibi positivity in patients with benign uniglandular parathyroid disease.

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Availability of data and material

All data are kept in the computers of the corresponding author (ETD).

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No custom code or software application was used during the preparation of the manuscript.

References

  1. Bilezikian JP. Primary hyperparathyroidism. J Clin Endocrinol Metab. 2018;103(11):3993–4004.

    Article  Google Scholar 

  2. DeLellis RA, Arnold A, Eng C, Erickson LA, Franssila KO, et al. Parathyroid adenoma. In: Lloyd RV, Osamura RY, Klöppel G, Rosai J, editors., et al., WHO classification of Tumours of Endocrine Organs. 4th ed. Lyon: WHO Press; 2017. p. 153–8.

    Google Scholar 

  3. Juhlin CC, Erickson LA. Genomics and epigenomics in parathyroid neoplasia: from bench to surgical pathology practice. Endocr Pathol. 2021;32(1):17–34.

    Article  Google Scholar 

  4. Duan K, Hernandez KG, Mete O. Clinicopathological correlates of hyperparathyroidism. J Clin Pathol. 2015;68(10):771–87.

    Article  CAS  Google Scholar 

  5. Greene AB, Butler RS, McIntyre S, Barbosa GF, Mitchell J, Berber E, et al. National trends in parathyroid surgery from 1998 to 2008: a decade of change. J Am Coll Surg. 2009;209(3):332–43.

    Article  Google Scholar 

  6. Kobylecka M, Koperski Ł, Chudziński W, Pihowicz P, Mączewska J, Płazińska MT, et al. Relationship between parathyroid gland scintigraphy and its histopathology, oxyphil cell content and volume: a retrospective study. Nucl Med Rev. 2019;22(1):29–33.

    Google Scholar 

  7. Hoang TD, Jani AG, Mai VQ, Tuamokumo FO, Shakir MK. Associations of serum ionized calcium, phosphate, and PTH levels with parathyroid scan in primary hyperparathyroidism. Endocr Pract. 2019;25(1):16–22.

    Article  Google Scholar 

  8. Kim D, Rhodes JA, Hashim JA, Rickabaugh L, Brams DM, Pinkus E, et al. Highly specific preoperative selection of solitary parathyroid adenoma cases in primary hyperparathyroidism by quantitative image analysis of the early-phase Technetium-99m sestamibi scan. J Med Imaging Radiat Oncol. 2018;62(5):642–8.

    Article  Google Scholar 

  9. Erovic BM, Goldstein DP, Asa SL, Janik S, Mete O, Irish JC. VEGFR-2 is downregulated in sestamibi-negative parathyroid adenomas. Head Neck. 2019;41(10):3564–9.

    Article  Google Scholar 

  10. Pons F, Torregrosa J, Fuster D. Biological factors influencing parathyroid localization. Nucl Med Commun. 2003;24(2):121–4.

    Article  CAS  Google Scholar 

  11. Hetrakul N, Civelek AC, Stagg CA, Udelsman R. In vitro accumulation of technetium-99m-sestamibi in human parathyroid mitochondria. Surgery. 2001;130(6):1011–8.

    Article  CAS  Google Scholar 

  12. Carpentier A, Jeannotte S, Verreault J, Lefebvre B, Bisson G, Mongeau C-J, et al. Preoperative localization of parathyroid lesions in hyperparathyroidism: relationship between technetium-99m-MIBI uptake and oxyphil cell content. J Nucl Med. 1998;39(8):1441–4.

    CAS  PubMed  Google Scholar 

  13. Westreich RW, Brandwein M, Mechanick JI, Bergman DA, Urken ML. Preoperative parathyroid localization: correlating false-negative technetium 99m sestamibi scans with parathyroid disease. Laryngoscope. 2003;113(3):567–72.

    Article  Google Scholar 

  14. Bleier BS, LiVolsi VA, Chalian AA, Gimotty PA, Botbyl JD, Weber RS. Technetium Tc 99m sestamibi sensitivity in oxyphil cell-dominant parathyroid adenomas. Arch Otolaryngol-Head Neck Surg. 2006;132(7):779–82.

    Article  Google Scholar 

  15. Erbil Y, Kapran Y, İşsever H, Barbaros U, Adalet I, Dizdaroğlu F, et al. The positive effect of adenoma weight and oxyphil cell content on preoperative localization with 99mTc-sestamibi scanning for primary hyperparathyroidism. Am J Surg. 2008;195(1):34–9.

    Article  Google Scholar 

  16. Melloul M, Paz A, Koren R, Cytron S, Feinmesser R, Gal R. 99m Tc-MIBI scintigraphy of parathyroid adenomas and its relation to tumour size and oxyphil cell abundance. Eur J Nucl Med. 2001;28(2):209–13.

    Article  CAS  Google Scholar 

  17. Fang L, Tang B, Hou D, Meng M, Xiong M, Yang J. Relationship between parathyroid mass and parathyroid hormone level in hemodialysis patients with secondary hyperparathyroidism. BMC Nephrol. 2015;16(1):1–7.

    Article  CAS  Google Scholar 

  18. Chen CC, Skarulis MC, Fraker DL, Alexander HR, Marx SJ, Spiegel AM. Technetium-99m-sestamibi imaging before reoperation for primary hyperparathyroidism. J Nucl Med. 1995;36(12):2186–91.

    CAS  PubMed  Google Scholar 

  19. Eslamy HK, Ziessman HA. Parathyroid scintigraphy in patients with primary hyperparathyroidism: 99mTc sestamibi SPECT and SPECT/CT. Radiographics. 2008;28(5):1461–76.

    Article  Google Scholar 

  20. Denham DW, James NM. Cost-effectiveness of preoperative sestamibi scan for primary hyperparathyroidism is dependent solely upon the surgeon’s choice of operative procedure. J Am Coll Surg. 1998;186(3):293–305.

    Article  CAS  Google Scholar 

  21. Huang Z, Lou C. 99mTcO4-/99mTc-MIBI dual-tracer scintigraphy for preoperative localization of parathyroid adenomas. J Int Med Res. 2019;47(2):836–45.

    Article  Google Scholar 

  22. Moghadam RN, Amlelshahbaz AP, Namiranian N, Sobhan-Ardekani M, Emami-Meybodi M, Dehghan A, et al. Comparative diagnostic performance of ultrasonography and 99mTc-sestamibi scintigraphy for parathyroid adenoma in primary hyperparathyroidism; systematic review and meta-analysis. Asian Pac J Cancer Prev. 2017;18(12):3195.

    PubMed Central  Google Scholar 

  23. Merlino JI, Ko K, Minotti A, McHenry CR. The false negative technetium-99m-sestamibi scan in patients with primary hyperparathyroidism: correlation with clinical factors and operative findings/discussion. Am Surg. 2003;69(3):225.

    PubMed  Google Scholar 

  24. Geysen A, Decallonne B, Vander Poorten V, Deroose CM, Van Laere K, Goffin K, et al. Influence of medication and PTH levels on detection of parathyroid adenomas with dual isotope parathyroid scintigraphy. Am J Nucl Med Mol Imaging. 2021;11(3):207.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Wong KK, Fig LM, Gross MD, Dwamena BA. Parathyroid adenoma localization with 99mTc-sestamibi SPECT/CT: a meta-analysis. Nucl Med Commun. 2015;36(4):363–75.

    Article  CAS  Google Scholar 

  26. Baser OO, Koseoglu D, Cetin Z, Catak M, Berker D. The Detection of preoperative parathyroid lesions: the success of ultrasonography, technetium-99m methoxyisobutylisonitrile parathyroid scintigraphy and spect-CT. Endocr Pract. 2021. https://doi.org/10.1016/j.eprac.2021.07.010.

    Article  Google Scholar 

  27. Filser B, Uslar V, Weyhe D, Tabriz N. Predictors of adenoma size and location in primary hyperparathyroidism. Langenbeck’s Arch Surg. 2021. https://doi.org/10.1007/s00423-021-02179-9.

    Article  Google Scholar 

  28. Mshelia DS, Hatutale A, Mokgoro N, Nchabaleng M, Buscombe JR, Sathekge MM. Correlation between serum calcium levels and dual-phase 99mTc-sestamibi parathyroid scintigraphy in primary hyperparathyroidism. Clin Physiol Funct Imaging. 2012;32(1):19–24.

    Article  CAS  Google Scholar 

  29. Parikshak M, Castillo ED, Conrad MF, Talpos GB. Impact of hypercalcemia and parathyroid hormone level on the sensitivity of preoperative sestamibi scanning for primary hyperparathyroidism/Discussion. Am Surg. 2003;69(5):393.

    PubMed  Google Scholar 

  30. Khorasani N, Mohammadi A. Effective factors on the sensitivity of preoperative sestamibi scanning for primary hyperparathyroidism. Int J Clin Exp Med. 2014;7(9):2639.

    PubMed  PubMed Central  Google Scholar 

  31. Gungor S, Dede F, Can B, Keskin H, Aras M, Ones T, et al. The value of parathyroid scintigraphy on lesion detection in patients with normocalcemic primary hyperparathyroidism. Revista Española de Medicina Nuclear e Imagen Molecular (English Edition). 2021. https://doi.org/10.1016/j.remnie.2020.12.007.

    Article  Google Scholar 

  32. Siegel A, Alvarado M, Barth RJ Jr, Brady M, Lewis J. Parameters in the prediction of the sensitivity of parathyroid scanning. Clin Nucl Med. 2006;31(11):679–82.

    Article  Google Scholar 

  33. Staudenherz A, Abela C, Niederle B, Steiner E, Helbich T, Puig S, et al. Comparison and histopathological correlation of three parathyroid imaging methods in a population with a high prevalence of concomitant thyroid diseases. Eur J Nucl Med. 1997;24(2):143–9.

    Article  CAS  Google Scholar 

  34. Mehta NY, Ruda JM, Kapadia S, Boyer PJ, Hollenbeak CS, Stack BC. Relationship of technetium Tc 99m sestamibi scans to histopathological features of hyperfunctioning parathyroid tissue. Arch Otolaryngol-Head Neck Surg. 2005;131(6):493–8.

    Article  Google Scholar 

  35. Cermik TF, Puyan FO, Sezer A, Firat MF, Berkarda S. Relation between Tc-99m sestamibi uptake and biological factors in hyperparathyroidism. Ann Nucl Med. 2005;19(5):387–92.

    Article  Google Scholar 

  36. Westerdahl J, Bergenfelz A. Sestamibi scan–directed parathyroid surgery: potentially high failure rate without measurement of intraoperative parathyroid hormone. World J Surg. 2004;28(11):1132–8.

    Article  Google Scholar 

  37. Goldstein RE, Billheimer D, Martin WH, Richards K. Sestamibi scanning and minimally invasive radioguided parathyroidectomy without intraoperative parathyroid hormone measurement. Ann Surg. 2003;237(5):722.

    PubMed  PubMed Central  Google Scholar 

  38. Mete O, Asa SL. Oncocytes, oxyphils, Hürthle, and Askanazy cells: morphological and molecular features of oncocytic thyroid nodules. Endocr Pathol. 2010;21(1):16–24.

    Article  Google Scholar 

  39. Erickson LA. Parathyroid gland. In: Mete O, Sylvia LA, editors. Endocrine pathology. Cambridge: Cambridge University Press; 2016. p. 573–87.

    Google Scholar 

  40. Slack JM. Metaplasia and transdifferentiation: from pure biology to the clinic. Nat Rev Mol Cell Biol. 2007;8(5):369–78.

    Article  CAS  Google Scholar 

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Acknowledgements

The authors would like to thank Hasan Bulut from the Department of Statistics for statistical analysis.

Funding

The authors did not receive support from any organization for the submitted work. The authors have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. Department of Endocrinology and Metabolism, School of Medicine, Ondokuz Mayis University, Samsun, Turkey

    Elif Tutku Durmuş, Ayşegül Atmaca & Ramis Çolak

  2. Department of Pathology, School of Medicine, Ondokuz Mayis University, Samsun, Turkey

    Mehmet Kefeli & Deniz Bayçelebi

  3. Department of Pathology, University Health Network, Toronto, Ontario, Canada

    Özgür Mete

  4. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada

    Özgür Mete

  5. Department of Nuclear Medicine, School of Medicine, Ondokuz Mayis University, Samsun, Turkey

    Fevziye Canbaz Tosun

  6. Department of General Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey

    Cafer Polat

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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by ETD. Endocrinologic data interpretation was performed by AA, ETD and RC. The operations were performed by CP. Surgical specimens were reviewed by MK and DB. Evaluation of nuclear medicine imaging was performed by FCT. The first draft of the manuscript was written by ETD and edited by AA, MK and OM. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Elif Tutku Durmuş.

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The authors have no conflicts of interest to declare that are relevant to the content of this article.

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The study was approved by the Ondokuz Mayis University School of Medicine, Medical Ethics Committe (IRB No: OMU KAEK 2019/430).

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Informed consent was not required due to the retrospective design of the study.

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All authors approved the final version and publication of the manuscript.

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Durmuş, E.T., Atmaca, A., Kefeli, M. et al. Clinicopathological variables that correlate with sestamibi positivity in uniglandular parathyroid disease: a retrospective analysis of 378 parathyroid adenomas. Ann Nucl Med 36, 33–42 (2022). https://doi.org/10.1007/s12149-021-01681-w

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  • DOI: https://doi.org/10.1007/s12149-021-01681-w

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