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Ultrastructural Histology Correlates with Results of Thallium-201/Technetium-99m Parathyroid Subtraction Scintigraphy

Department of Nuclear Medicine, Warren G. Magnuson Clinical Center, Laboratory of Pathology and Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland

Correspondence: For reprints or correspondence contact: Dirk Sandrock, MD, Georg-August-University, Department of Nuclear Medicine, Robert-Koch-Str. 40, D-3400 Goettingen, Germany.

ABSTRACT

Specimens from 15 scintigraphically true-positive adenomas (golden standard: histology), 15 false-negative adenomas, 15 true-positive hyperplasias, 15 false-negative hyperplasias, 15 true-negative normal glands from patients with hyperparathyroidism, and 15 normal glands from patients without hyperparathyroidism, all selected randomly, were studied. After fixation, sectioning and H and E staining, in all 90 tissues the number of oxyphil, chief, and clear cells was counted in five randomly selected squares (103 x 103 µm). In 30 tissues, the number of mitochondria per cell was counted in five randomly selected cells from each lesion in transmission electron photomicrographs. Total cell counts in each group and number of chief cells showed no correlation with lesion detectability by scintigraphy. However, true-positive lesions had a significantly higher number of oxyphil cells than false-negative or normal glands. Twenty-one of 30 true-positive lesions had a oxyphil-to-clear cell ratio > 1; in contrast to only two of 30 false-negative lesions and 0 of 30 normal glands (p < 0.0005). The number of mitochondria per cell was higher in oxyphil cells in true-positive lesions (adenomas: 155 ± 58, hyperplasias: 55 ± 18) than in chief or clear cells in false-negative or normal lesions (30 ± 15, p < 0.001). Our data suggest that the detectability of abnormal parathyroid glands by ²⁰¹Tl/^99mTc subtraction scintigraphy is in part dependent upon the presence of mitochondria-rich oxyphil cells.

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