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^99mTc-Sestamibi and ¹³¹I Whole-Body Scintigraphy and Initial Serum Thyroglobulin in the Management of Differentiated Thyroid Carcinoma

Department of Nuclear Medicine, Singapore General Hospital, Singapore

Correspondence: For correspondence or reprints contact: David Chee Eng Ng, MD, Department of Nuclear Medicine, Block 2 Basement 1, Singapore General Hospital, Outram Rd., Singapore 169608.

ABSTRACT

^99mTc-sestamibi whole-body scanning has been used in the postoperative assessment of differentiated thyroid carcinoma together with ¹³¹I whole-body scanning and serum thyroglobulin (Tg) estimation. This study compared ^99mTc-sestamibi whole-body scanning with ¹³¹I whole-body scanning in the context of initial serum Tg levels of patients after total or near-total thyroid-ectomy who were taken off thyroxine suppression therapy and who had no ¹³¹I ablation before surgery. Methods: A prospective study of 360 patients was undertaken. ^99mTc-sestamibi whole-body scintigraphy was performed at least 5 wk after thyroidectomy and was followed by ¹³¹I whole-body scanning. The patients had no thyroxine suppression for 5 wk, and Tg was measured thereafter. Radiologic studies (chest radiography, CT, MRI, son-ography, and bone scanning) and histopathologic examinations were performed to clarify the presence of metastases with positive uptake on either ^99mTc-sestamibi scans or ¹³¹I whole-body scans. Positive scans were defined as those with the presence of thyroid remnants, lymph node disease, or metastases. Results: Two hundred fifty-nine (71.9%) of the 360 patients had initial serum Tg levels < 30 ng/mL (group 1), whereas 101 (28.1%) had initial serum Tg levels 30 ng/mL (group 2). Of the 259 group 1 patients, 82 had positive ^99mTc-sestamibi scans and 113 had positive ¹³¹I scans; 71.7% of patients with positive ¹³¹I scans also had positive ^99mTc-sestamibi scans, and 98.8% of patients with positive ^99mTc-sestamibi scans also had positive ¹³¹I scans. Of the 101 group 2 patients, 81 had positive ^99mTc-sestamibi scans and 97 had positive ¹³¹I scans; 83.5% of patients with positive ¹³¹I scans also had positive ^99mTc-sestamibi scans, and all patients with positive ^99mTc-sestamibi scans also had positive ¹³¹I scans. Of those with initial serum Tg levels a 30 ng/mL (group 2), 27.2% had thyroid remnants and 68.8% had lymph node disease or metastases. ¹³¹I scanning detects more thyroid remnants and lung metastases than does ^99mTc-sestamibi scanning. Conclusion: Our findings suggest that, compared with ¹³¹I scanning, ^99mTc-sestamibi scanning is less sensitive in detecting thyroid remnants and lung metastases but appears to be more useful in the detection of lymph node disease before initial¹³¹I treatment.

Key Words: thyroid cancer • radioiodine • whole-body scintigraphy

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