P-glycoprotein expression influences the result of 99mTc-MIBI scintigraphy in tertiary hyperparathyroidism.
Precise localization of parathyroid glands using 99mTc-labeled hexakis-2-methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy could be affected by various biological factors. There is increasing evidence that radiotracer retention could be controlled by members of multidrug resistance (MDR) system, especially P-glycoprotein (P-gp). Since the role of P-gp in tertiary hyperparathyroidism (T-HPTH) scintigraphic studies is poorly recognized, the aim of the study was to compare the correlation between parathyroid P-gp expression and results of their scintigraphy in T-HPTH versus primary hyperparathyroidism (P-HPTH). P-HPTH (n = 19) and T-HPTH (n = 18) patients were subjected to 99mTc-MIBI scintigraphy followed by surgical treatment. The parathyroid glands were assessed in routine hematoxylin-eosin staining and P-gp expression was analyzed using immunohistochemistry. Parathyroids collected during cadaver donor multi-organ harvesting were used as a control. It has been found that P-HPTH-derived parathyroid glands with predominating adenoma morphology expressed less P-gp, as compared to P-gp-rich T-HPTH glands, mainly displaying nodular or diffused hyperplasia phenotype. This finding reversely correlated with results of 99mTc-MIBI scintigraphy. However, we did not observe any difference in P-gp expression nor scintigraphy result between nodular or diffused hyperplasia. Altogether, these data suggest that P-gp overexpression in T-HPTH could be responsible for decreased sensitivity of 99mTc-MIBI scintigraphy in those patients. Therefore, the recently proposed reduced neck exploration or limited parathyroid resection on the basis of scintigraphy could create the risk of persisted/recurrent hyperparathyroidism. However, this problem requires further study.
Chudzinski
Witold
W
Department of General, Vascular and Transplant Surgery, Central University Hospital, Warsaw, Poland.
Niderla
Justyna
J
Lasiecka
Zofia
Z
Wilczynski
Grzegorz
G
Gornicka
Barbara
B
Wasiutynski
Aleksander
A
Maczewska
Joanna
J
Kobylecka
Malgorzata
M
Krolicki
Leszek
L
Durlik
Magdalena
M
Nowacka
Ewa
E
Lazarczyk
Maciej
M
Dziunycz
Piotr
P
Milewski
Lukasz
L
Nawrot
Ireneusz
I
Grzela
Tomasz
T
D018435:ATP Binding Cassette Transporter, Subfamily B / Q000096:biosynthesis*; D000236:Adenoma / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D006801:Humans; D006961:Hyperparathyroidism / Q000145:classification / Q000000981:diagnostic imaging* / Q000378:metabolism; D006965:Hyperplasia; D007150:Immunohistochemistry; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi / Q000493:pharmacokinetics
D018435:ATP Binding Cassette Transporter, Subfamily B; D017256:Technetium Tc 99m Sestamibi