Retrospective imaging study on the diagnosis of pathological false positive iodine-131 scans in patients with thyroid cancer

Jia,Qiang; Meng,Zhaowei; Tan,Jian; Zhang,Guizhi; He,Yajing; Sun,Haoran; Yu,Chunshui; Li,Dong; Zheng,Wei; Wang,Renfei; Wang,Shen; Li,Xue; Zhang,Jianping; Hu,Tianpeng; Liu,Na; Upadhyaya,Arun

doi:10.3892/etm.2015.2744

Retrospective imaging study on the diagnosis of pathological false positive iodine-131 scans in patients with thyroid cancer

Authors:
- Qiang Jia
- Zhaowei Meng
- Jian Tan
- Guizhi Zhang
- Yajing He
- Haoran Sun
- Chunshui Yu
- Dong Li
- Wei Zheng
- Renfei Wang
- Shen Wang
- Xue Li
- Jianping Zhang
- Tianpeng Hu
- Na Liu
- Arun Upadhyaya
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Affiliations: Department of Nuclear Medicine, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China, Department of Radiology, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
Published online on: September 11, 2015 https://doi.org/10.3892/etm.2015.2744
Pages: 1995-2001

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Abstract

Iodine-131 (I-131) therapy and post-therapy I-131 scanning are essential in the management of differentiated thyroid cancer (DTC). However, pathological false positive I‑131 scans can lead to misdiagnosis and inappropriate I‑131 treatment. This retrospective study aimed to investigate the best imaging modality for the diagnosis of pathological false positive I‑131 scans in a DTC patient cohort, and to determine its incidence. DTC patient data archived from January 2008 to January 2010 was retrieved. Post‑therapeutic I‑131 scans were conducted and interpreted. The imaging modalities of magnetic resonance imaging (MRI), computed tomography and ultrasonography were applied and compared to check all suspected lesions. Biopsy or needle aspiration was conducted for patients who consented to the acquisition of histopathological confirmation. Data for 156 DTC patients were retrieved. Only 6 cases of pathological false‑positives were found among these (incidence, 3.85%), which included 3 cases of thymic hyperplasia in the mediastinum, 1 case of pleomorphic adenoma in the parapharyngeal space and 1 case of thyroglossal duct cyst in the neck. MRI was demonstrated as the best imaging modality for diagnosis due to its superior soft tissue resolution. However, no imaging modality was able to identify the abdominal false positive‑lesions observed in 2 cases, one of whom also had thymic hyperplasia. In conclusion, pathological false positive I-131 scans occurred with an incidence of 3.85%. MRI was the best imaging modality for diagnosing these pathological false-positives.

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1	Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Sherman SI and Tuttle RM: American Thyroid Association Guidelines Taskforce: Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 16:109–142. 2006. View Article : Google Scholar : PubMed/NCBI
2	American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, et al: Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 19:1167–1214. 2009. View Article : Google Scholar : PubMed/NCBI
3	Carlisle MR, Lu C and McDougall IR: The interpretation of ¹³¹I scans in the evaluation of thyroid cancer, with an emphasis on false positive findings. Nucl Med Commun. 24:715–735. 2003. View Article : Google Scholar : PubMed/NCBI
4	van Sorge-van Boxtel RA, van Eck-Smit BL and Goslings BM: Comparison of serum thyroglobulin, ¹³¹I and ²⁰¹Tl scintigraphy in the postoperative follow-up of differentiated thyroid cancer. Nucl Med Commun. 14:365–372. 1993. View Article : Google Scholar : PubMed/NCBI
5	Lubin E, Mechlis-Frish S, Zatz S, Shimoni A, Segal K, Avraham A, Levy R and Feinmesser R: Serum thyroglobulin and iodine-131 whole-body scan in the diagnosis and assessment of treatment for metastatic differentiated thyroid carcinoma. J Nucl Med. 35:257–262. 1994.PubMed/NCBI
6	McDougall IR: Whole-body scintigraphy with radioiodine-131. A comprehensive list of false-positives with some examples. Clin Nucl Med. 20:869–875. 1995. View Article : Google Scholar : PubMed/NCBI
7	Sawka AM, Thabane L, Parlea L, Ibrahim-Zada I, Tsang RW, Brierley JD, Straus S, Ezzat S and Goldstein DP: Second primary malignancy risk after radioactive iodine treatment for thyroid cancer: A systematic review and meta-analysis. Thyroid. 19:451–457. 2009. View Article : Google Scholar : PubMed/NCBI
8	Rubino C, de Vathaire F, Dottorini ME, Hall P, Schvartz C, Couette JE, Dondon MG, Abbas MT, Langlois C and Schlumberger M: Second primary malignancies in thyroid cancer patients. Br J Cancer. 89:1638–1644. 2003. View Article : Google Scholar : PubMed/NCBI
9	Shapiro B, Rufini V, Jarwan A, Geatti O, Kearfott KJ, Fig LM, Kirkwood ID and Gross MD: Artifacts, anatomical and physiological variants, and unrelated diseases that might cause false-positive whole-body 131-I scans in patients with thyroid cancer. Semin Nucl Med. 30:115–132. 2000. View Article : Google Scholar : PubMed/NCBI
10	Sutter CW, Masilungan BG and Stadalnik RC: False-positive results of I-131 whole-body scans in patients with thyroid cancer. Semin Nucl Med. 25:279–282. 1995. View Article : Google Scholar : PubMed/NCBI
11	Greenler DP and Klein HA: The scope of false-positive iodine-131 images for thyroid carcinoma. Clin Nucl Med. 14:111–117. 1989. View Article : Google Scholar : PubMed/NCBI
12	Bakheet SM and Hammami MM: False-positive radioiodine whole-body scan in thyroid cancer patients due to unrelated pathology. Clin Nucl Med. 19:325–329. 1994. View Article : Google Scholar : PubMed/NCBI
13	Mitchell G, Pratt BE, Vini L, McCready VR and Harmer CL: False positive 131I whole body scans in thyroid cancer. Br J Radiol. 73:627–635. 2000. View Article : Google Scholar : PubMed/NCBI
14	Niendorf ER, Parker JA, Yechoor V, Garber JR and Boiselle PM: Thymic hyperplasia in thyroid cancer patients. J Thorac Imaging. 20:1–4. 2005. View Article : Google Scholar : PubMed/NCBI
15	Davidson J and McDougall IR: How frequently is the thymus seen on whole-body iodine-131 diagnostic and post-treatment scans? Eur J Nucl Med. 27:425–430. 2000. View Article : Google Scholar : PubMed/NCBI
16	Spitzweg C, Joba W, Eisenmenger W and Heufelder AE: Analysis of human sodium iodide symporter gene expression in extrathyroidal tissues and cloning of its complementary deoxyribonucleic acids from salivary gland, mammary gland and gastric mucosa. J Clin Endocrinol Metab. 83:1746–1751. 1998. View Article : Google Scholar : PubMed/NCBI
17	Meller J and Becker W: The human sodium-iodine symporter (NIS) as a key for specific thymic iodine-131 uptake. Eur J Nucl Med. 27:473–474. 2000. View Article : Google Scholar : PubMed/NCBI
18	Michigishi T, Mizukami Y, Shuke N, Yokoyama K, Noguchi M, Watanabe Y, Matsui O, Aburano T, Tonami N and Hisada K: Visualization of the thymus with therapeutic doses of radioiodine in patients with thyroid cancer. Eur J Nucl Med. 20:75–79. 1993. View Article : Google Scholar : PubMed/NCBI
19	Bozza F, Vigili MG, Ruscito P, Marzetti A and Marzetti F: Surgical management of parapharyngeal space tumours: Results of 10-year follow-up. Acta Otorhinolaryngol Ital. 29:10–15. 2009.PubMed/NCBI
20	Dimitrijevic MV, Jesic SD, Mikic AA, Arsovic NA and Tomanovic NR: Parapharyngeal space tumors: 61 case reviews. Int J Oral Maxillofac Surg. 39:983–989. 2010. View Article : Google Scholar : PubMed/NCBI
21	Sergi B, Limongelli A, Scarano E, Fetoni AR and Paludetti G: Giant deep lobe parotid gland pleomorphic adenoma involving the parapharyngeal space. Report of three cases and review of the diagnostic and therapeutic approaches. Acta Otorhinolaryngol Ital. 28:261–265. 2008.PubMed/NCBI
22	Papadogeorgakis N, Petsinis V, Goutzanis L, Kostakis G and Alexandridis C: Parapharyngeal space tumors: Surgical approaches in a series of 13 cases. Int J Oral Maxillofac Surg. 39:243–250. 2010. View Article : Google Scholar : PubMed/NCBI
23	Shi H, Wang P, Wang S and Yu Q: Pleomorphic adenoma with extensive ossified and calcified degeneration: Unusual CT findings in one case. AJNR Am J Neuroradiol. 29:737–738. 2008. View Article : Google Scholar : PubMed/NCBI
24	Basaria S, Westra WH and Cooper DS: Ectopic lingual thyroid masquerading as thyroid cancer metastases. J Clin Endocrinol Metab. 86:392–395. 2001. View Article : Google Scholar : PubMed/NCBI
25	Zanotti-Fregonara P, Hindié E, Keller I, Calzada-Nocaudie M and Devaux JY: Scintigraphic visualization of glossal thyroid tissue during the follow-up of thyroid cancer patients. Clin Nucl Med. 32:911–914. 2007. View Article : Google Scholar : PubMed/NCBI
26	Li D, Meng Z, Zhang G, Yu T, Tan J and Dong F: Visualization of thyroglossal duct cyst in differentiated thyroid cancer patient. Clin Nucl Med. 35:499–504. 2010. View Article : Google Scholar : PubMed/NCBI
27	Kaplan SL, Mandel SJ, Muller R, Baloch ZW, Thaler ER and Loevner LA: The role of MR imaging in detecting nodal disease in thyroidectomy patients with rising thyroglobulin levels. AJNR Am J Neuroradiol. 30:608–612. 2009. View Article : Google Scholar : PubMed/NCBI
28	Gross ND, Weissman JL, Talbot JM, Andersen PE, Wax MK and Cohen JI: MRI detection of cervical metastasis from differentiated thyroid carcinoma. Laryngoscope. 111:1905–1909. 2001. View Article : Google Scholar : PubMed/NCBI
29	Toubert ME, Cyna-Gorse F, Zagdanski AM, Noel-Wekstein S, Cattan P, Billotey C, Sarfati E and Rain JD: Cervicomediastinal magnetic resonance imaging in persistent or recurrent papillary thyroid carcinoma: Clinical use and limits. Thyroid. 9:e-5971999. View Article : Google Scholar