Unit of Surgery, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples (SUN), Naples, Italy.
VII Unit of Surgery, Department of Surgical, Anesthesiological and Emergency Sciences, Second University of Naples (SUN), Naples, Italy.
Int J Surg. 2017 May;41 Suppl 1:S75-S81. doi: 10.1016/j.ijsu.2017.03.081.
The diagnosis of thyroid nodular diseases requires an integrated approach that has been widely established over the past years. This strategy includes: ultrasonography (US) with; implemented Color-Power-Doppler, conventional scintigraphy also with positive indicators, specific pathological studies targeted by immunohistochemically-assays, and the fine needle; aspiration biopsy (FNAB), which, usually, in case of "Follicular Lesions" (10-20%) findings is; unable to distinguish carcinoma from follicular adenoma, then indicating the necessity of surgery to; obtain a correct diagnosis. The aim of this study was to evaluate the role of the scintigraphy with; positive indicators, both preoperatively in diagnostic approach of the thyroid nodules and; intraoperatively as a guide to the extension of the surgical excision.
On 4482 Thyroidectomy performed, we selected 360 cases of follicular neoplasms (192; females and 168 males). In the preoperative phase, these patients underwent 99 m Tc-sestaMIBI; scintigraphy with both early (10 min) and late (2 h) image acquisition, which were later; compared to the ones obtained by image subtraction of means 99 m Tc-pertechnetate. Following the; sestamibi administration before intervention, we selected the most up-taking nodularity with the; assistance of a specific surgical probe (Neoprobe), quantifying uptake with relation to the surgical pathology, for an amount of 324 total thyroidectomies and 36 hemi thyroidectomies.
In all cases of multinodular goiter the benign nodules showed an intraoperative low sestamibi uptake whereas follicular carcinomas showed both a high preoperative uptake and, as a; percentage, the highest values of intraoperative uptake; on the other hand, follicular adenomas had; both pre-and intraoperative mean values of uptake. On the contrary, papillary carcinomas only; showed a mild uptake.
Preoperative sestamibi scintigraphy confirmed its importance in improving the information obtained through different diagnostic investigations. Also intraoperatively, it pointed; out high-risk nodules more accurately. Therefore, radio (Sestamibi) guided surgery could have an; interesting rule in the thyroid follicular lesion treatment.
甲状腺结节疾病的诊断需要一种综合的方法，这种方法在过去几年中已经得到广泛应用。该策略包括：超声检查（US）结合彩色能量多普勒；常规闪烁扫描术也有阳性指标，通过免疫组织化学检测靶向特定的病理研究，以及细针抽吸活检（FNAB），通常在“滤泡性病变”（10-20%）的情况下，无法区分癌与滤泡性腺瘤，然后需要手术以获得正确的诊断。本研究旨在评估闪烁扫描术的作用，包括：术前在甲状腺结节的诊断方法中以及术中作为手术切除范围的指导的阳性指标。
在进行的 4482 例甲状腺切除术，我们选择了 360 例滤泡性肿瘤（192 例女性和 168 例男性）。在术前阶段，这些患者接受了 99mTc-sestaMIBI 闪烁扫描术，采集了早期（10 分钟）和晚期（2 小时）图像，然后将其与 99mTc-过锝酸盐的图像减影进行比较。在干预前进行 sestamibi 给药后，我们使用特定的手术探针（Neoprobe）选择摄取最多的结节，定量摄取与手术病理学相关，共进行了 324 例全甲状腺切除术和 36 例半甲状腺切除术。
在所有多结节性甲状腺肿的病例中，良性结节在术中显示低 sestamibi 摄取，而滤泡性癌则显示术前摄取较高，并且作为一个百分比，术中摄取值最高；另一方面，滤泡性腺瘤具有摄取的术前和术中平均值。相反，乳头状癌仅显示轻度摄取。
术前 sestamibi 闪烁扫描术证实了其在提高通过不同诊断研究获得的信息的重要性。术中也更准确地指出了高危结节。因此，放射性（Sestamibi）引导手术在甲状腺滤泡性病变的治疗中可能具有有趣的规则。
