Valor de la gammagrafía con Tc-99m-tetrofosmín en el diagnóstico del cáncer bien diferenciado de tiroides
Por:
Gallegos-Hernández J.F., Pichardo-Romero P., Esparza-Pérez H., Reséndiz-Colosia J.A., Minauro-Muñoz G.G., Hernández-Hernández D.M.
Publicada:
1 ene 2009
Categoría:
Surgery
Resumen:
Background: Patients with cold thyroid nodules without ultrasound malignant suspicion and with benign/undetermined cytology may be subjected to follow-up surveillance. 99mTC-tetrofosmin scan (99mTC-TS) may identify patients where this observation can be performed with more certainty. Absence of uptake never occurs in carcinoma patients. Our objective was to determine the 99mTC-TS negative predictive value (NPV) in patients with cold thyroid nodules. Methods: An evaluation with 99mTC-TS was conducted prior to surgery in patients with thyroid gland tumor who were candidates for surgery. All patients underwent thyroidectomy according to histology; NPV and test sensitivity were evaluated when compared with the histopathological result. Then, 296-370 MBq (8-10 mCi) of 99mTC- tetrofosmin was administered; scan images were evaluated after 120 min. Scan result was reported as a) with increased metabolic activity (IMA) or b) without increased metabolic activity (WIMA). Results: Included in the study were 86 consecutive patients. In 60 patients, the scan showed IMA, 20/60 (33%) with carcinoma, 67% with benign nodule. In 26 (30.2%) the scan was WIMA, in this group 3/26 (11.5%) had carcinoma and (88.4%) had a benign neoplasia. Sensitivity = 91.43 (95% Cl = 80.73-100), specificity = 45.10 (95% Cl = 30.46-59.73), positive predictive value = 53.33 (95% Cl = 39.8-66.79) and NPV = 88.46 (95% Cl 74.26-100), Negative probability ratio = 0.19. Conclusions: IMA- 99mTC-TS is less specific in thyroid cancer; nevertheless, in WIMA patients the possibility of carcinoma is 13%. Most patients (70%) showed IMA, 33% with carcinoma. WIMA-NPV = 30%. 99mTC-TS may be useful in therapeutic decision of patients with thyroid nodule with concerns about surgery. Its usefulness lies in the NPV.
Filiaciones:
Gallegos-Hernández J.F.:
Departamento de Tumores de Cabeza y Cuello, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Av. Cuauhtémoc 330, Col. Doctores, Del. Cuauhté-moc, 06725, Mexico
Pichardo-Romero P.:
Departamento de Medicina Nuclear, Hospital de Oncología, Instituto Mexicano Del Seguro Social, Mexico
Esparza-Pérez H.:
Departamento de Medicina Nuclear, Hospital de Oncología, Instituto Mexicano Del Seguro Social, Mexico
Reséndiz-Colosia J.A.:
Departamento de Tumores de Cabeza y Cuello, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Av. Cuauhtémoc 330, Col. Doctores, Del. Cuauhté-moc, 06725, Mexico
Minauro-Muñoz G.G.:
Departamento de Medicina Nuclear, Hospital de Oncología, Instituto Mexicano Del Seguro Social, Mexico
Hernández-Hernández D.M.:
Departamento de Estadística y Epidemiología, Hospital de Oncología, Instituto Mexicano Del Seguro Social, Mexico
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