title: P-gp and MRP1 expression in parathyroid tumors related to histology, weight and (99m)Tc-sestamibi imaging results.
abstract: OBJECTIVE
  P-glycoprotein (P-gp) and multidrug resistance-associated protein (MRP) are membrane efflux pumps that may have a role in the kinetics of (99m)Tc-sestamibi (MIBI) in parathyroid tumors. P-gp and MRP1 expression in parathyroid tumors was studied and related to histology, weight and pre- and intraoperative MIBI imaging results.
  
  
  METHODS
  Patient cohort study
  
  
  METHODS
  Tertiary referral center
  
  
  METHODS
  Thirty-three patients underwent radioguided parathyroidectomy for primary or secondary hyperparathyroidism.
  
  
  METHODS
  P-gp and MRP1 expression.
  
  
  METHODS
  Dual-phase (99m)Tc-MIBI scintigraphy and SPECT results were compared to the surgical findings. Radioactivity and weight of resected parathyroid tumors were measured. Intraoperative radioactivity measurements were decay corrected. After routine histology immunohistochemistry was performed using C494 monoclonal antibodies to P-gp and MRP1r1 to MRP1. P-gp and MRP1 expression were scored covering both distribution of positivity and degree of immunostaining semi quantitatively.
  
  
  RESULTS
  P-gp and MRP1 staining was observed in 97% and 43% of the glands respectively. P-gp staining was positive in 91% (21/23) of the adenomas and in all 36 hyperplastic glands. MRP1 staining was positive in 22% (5/23) of the adenomas and in 61% (22/36) of the hyperplastic glands. P-gp or MRP1 expression did not correlate with preoperative (99m)Tc-MIBI imaging or intraoperative radioactivity. Parathyroid weight was associated with preoperative MIBI imaging results and MIBI uptake measured during surgery.
  
  
  CONCLUSIONS
  P-gp and MRP1 expression did not correlate with (99m)Tc-MIBI uptake in parathyroid tumors. Parathyroid weight remains the major known factor influencing (99m)Tc-MIBI uptake.
authors.affiliation: Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: F H
authors.initials: FH
authors.lastname: Jorna
authors.forename: H
authors.initials: H
authors.lastname: Hollema
authors.forename: H N
authors.initials: HN
authors.lastname: Hendrikse
authors.forename: J
authors.initials: J
authors.lastname: Bart
authors.forename: A H
authors.initials: AH
authors.lastname: Brouwers
authors.forename: J T M
authors.initials: JT
authors.lastname: Plukker
mesh_terms: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1 / Q000378:metabolism*; D000236:Adenoma / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000601:surgery; D000368:Aged; D001837:Body Weights and Measures; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000601:surgery; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000601:surgery; D006965:Hyperplasia / Q000000981:diagnostic imaging / Q000378:metabolism; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D027425:ATP-Binding Cassette, Sub-Family C Proteins / Q000378:metabolism*; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000601:surgery; D016105:Parathyroidectomy; D011877:Radionuclide Imaging; D017256:Technetium Tc 99m Sestamibi
chemical_list: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1; D027425:ATP-Binding Cassette, Sub-Family C Proteins; D017256:Technetium Tc 99m Sestamibi; C421109:multidrug resistance-associated protein 1