The Effect of Neck Physical Examination and Signing Thyroid Nodules by Lead Marker on 99mTcO4 Thyroid Scan Results

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Medical Physics and Medical Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 General Practitioner, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Statistician, Isfahan, Iran

4 Professor, Department of Medical Physics and Medical Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Thyroid nodules are of the most common thyroid diseases found in about half of adults. Diagnosis of nodules is clinically important because of the risk of cancer. Thyroid gland radionuclide scanning with 99mTcO4 helps the physician to choose better approach to the disease, knowing the activity of the nodule. Neck physical examination before scintigraphy and using a piece of lead marker specifies the location of the nodule in the scintigram to give a more distinct interpretation of the report of the scan.Methods: 117 patients with thyroid nodules referred to Seyyed Alshohada Hospital Nuclear Medicine Center (Isfahan, Iran) during 2012-2013 were studied. The patients underwent scanning with 99mTcO4 once; the next time, physical examination of the neck was done and then, scanning was applied; and for the last time, we put a lead marker on the palpated nodule in physical examination, then did the radionuclide scanning. The reports of three scanning tests were compared together.Findings: Regarding chi-square test, physical examination of neck and using a lead marker on the palpated thyroid nodule affected the reporting of the scintigram and caused reduction of the false-positive results in both cold and warm nodules (P < 0.05). Also regarding to Wald test, using both mentioned methods resulted in less mistakes in interpretations of the reports of the thyroid scanning.Conclusion: This study showed that, as a simple cost effective method, physical examination of thyroid gland and using lead marker through scintigraphy may be useful in diagnosis of thyroid nodules.

Keywords


  1. Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedus L, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and EuropeanThyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract 2010; 16 Suppl 1: 1-43.
  2. Ladenson P, Kim M. Thyroid. In: Goldman L, Schafer AI, editors. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Health Sciences; 2012. p. e233-2-e233-5.
  3. Schlumberger MJ, Filetti S, Hay ID. Nontoxic Diffuse and Nodular Goiter and Thyroid Neoplasia. In: Melmed Sh, Polonsky KS, Reed Larsen P, Kronenberg HM, editors. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier Health Sciences; 2011. p. 440-78.
  4. Bomeli SR, LeBeau SO, Ferris RL. Evaluation of a thyroid nodule. Otolaryngol Clin North Am 2010; 43(2): 229-38, vii.
  5. Elaraj DM. Evaluation of Thyroid Nodules. In: Sturgeon C, editor. Endocrine Neoplasia.New York, NY: Springer; 2009. p. 23-34.
  6. Bentley AA, Gillespie C, Malis D. Evaluation and management of a solitary thyroid nodule in a child. Otolaryngol Clin North Am 2003; 36(1): 117-28.
  7. Kim N, Lavertu P. Evaluation of a thyroid nodule. Otolaryngol Clin North Am 2003; 36(1): 17-33.
  8. Knox MA. Thyroid nodules. Am Fam Physician 2013; 88(3): 193-6.
  9. Nakamura H. Management for thyroid nodules. Nihon Rinsho 2012; 70(11): 1872-9. [In Japanese].
  10. Lienart F. Thyroid nodule: benign or malignant? Rev Med Brux 2012; 33(4): 254-62. [In French].
  11. Leidig-Bruckner G, Cichorowski G, Sattler P, Bruckner T, Sattler B. Evaluation of thyroid nodules--combined use of (99m)Tc-methylisobutylnitrile scintigraphy and aspiration cytology to assess risk of malignancy and stratify patients for surgical or nonsurgical therapy--a retrospective cohort study. Clin Endocrinol (Oxf) 2012; 76(5): 749-58.
  12. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19(11): 1167-214.
  13. Mazzaferi EL. Radioiodine and other treatments and outcomes. In: Werner SC, Ingbar SH, Braverman LE, Utiger RD, editors. Werner and Ingbar's the thyroid: a fundamental and clinical text. 7th ed. Philadelphia, PA: Lippincott-Raven; 1996. p. 922-43.
  14. Milas Z, Shin J, Milas M. New guidelines for the management of thyroid nodules and differentiated thyroid cancer. Minerva Endocrinol 2011; 36(1): 53-70.
  15. Alzahrani AS, Ceresini G, Aldasouqi SA. Role of ultrasonography in the differential diagnosis of thyrotoxicosis: a noninvasive, cost-effective, and widely available but underutilized diagnostic tool. Endocr Pract 2012; 18(4): 567-78.
  16. Wong KT, Ahuja AT. Ultrasound of thyroid cancer. Cancer Imaging 2005; 5: 157-66.
  17. Meah FA, Qureshi MA. Managing the solitary thyroid nodule. Med J Malaysia 1998; 53(4): 453-6.
  18. Saber RA, Wagih S, Sedik A, Fawzy A. Evaluation of Solitary Thyroid Cold Nodules with Technetium-99m Sestamibi and Thallium-201. Journal of the Egyptian Nat Cancer Ins 2001; 13(2): 147-55.
  19. Broome MR. Thyroid scintigraphy in hyperthyroidism. Clin Tech Small Anim Pract 2006; 21(1): 10-6.
  20. Lee ES, Kim JH, Na DG, Paeng JC, Min HS, Choi SH, et al. Hyperfunction thyroid nodules: their risk for becoming or being associated with thyroid cancers. Korean J Radiol 2013; 14(4): 643-52.
  21. Burger AG, Graf D, Helmich-Kapp B, Graf S, Veit F, Lehmann N, et al. Should 99mTcO4 Thyroid Scintigraphy Still Be Used In Investigating Thyroid Nodules In Multinodular Goiter? Clin Thyroidol 2013; 25: 13-5.
  22. Gorges R, Kandror T, Kuschnerus S, Zimny M, Pink R, Palmedo H, et al. Scintigraphically "hot" thyroid nodules mainly go hand in hand with a normal TSH. Nuklearmedizin 2011; 50(5): 179-88. [In German].
  23. Cases JA, Surks MI. The changing role of scintigraphy in the evaluation of thyroid nodules. Semin Nucl Med 2000; 30(2): 81-7.
  24. Boi F, Lai ML, Deias C, Piga M, Serra A, Uccheddu A, et al. The usefulness of 99mTc-SestaMIBI scan in the diagnostic evaluation of thyroid nodules with oncocytic cytology. Eur J Endocrinol 2003; 149(6): 493-8.
  25. Carneiro-Pla D. Ultrasound elastography in the evaluation of thyroid nodules for thyroid cancer. Curr Opin Oncol 2013; 25(1): 1-5.
  26. Bennedbaek FN, Hegedus L. Management of the solitary thyroid nodule: results of a North American survey. J Clin Endocrinol Metab 2000; 85(7): 2493-8.
  27. Bennedbaek FN, Perrild H, Hegedus L. Diagnosis and treatment of the solitary thyroid nodule. Results of a European survey. Clin Endocrinol (Oxf) 1999; 50(3): 357-63.
  28. Sabel MS, Staren ED, Gianakakis LM, Dwarakanathan S, Prinz RA. Effectiveness of the thyroid scan in evaluation of the solitary thyroid nodule. Am Surg 1997; 63(7): 660-3.