title: Management of thyroid nodules incidentally discovered on MIBI scanning for primary hyperparathyroidism.
abstract: BACKGROUND
  Parathyroid sestamibi scan is routinely performed before parathyroid surgery. A large number of thyroid cancers take up 99mTc-sestamibi (MIBI). Since 2001, thyroid nodules discovered on sestamibi, nodules >2 cm, and/or with suspicious criteria were resected. The aim of this study was to evaluate the results of this policy.
  
  
  METHODS
  All patients operated on for hyperparathyroidism, with a MIBI and cervical ultrasonography (US) with a thyroid resection for nodule, were retrospectively included.
  
  
  RESULTS
  From 2001 to 2013, 685 patients were operated on for hyperparathyroidism. Some 137 (85 % females) had both preoperative MIBI and cervical US and a thyroid resection. The mean age was 63.2 ± 12.8 years. Sixty-three patients had a total thyroidectomy and 74 a lobectomy. Thirty-six patients had a thyroid cancer. The median size of cancers was 6.5 mm (0.3-22 mm), and 23 (16.7 %) patients had microcarcinoma. Among the 137 patients, 44 (32 %) had a MIBI+ nodule including 22 cancers. Sixty-one percent of malignant nodules were MIBI+ (22/36). The median size of MIBI+ cancers was 15 mm (9-22 mm) versus 2 mm (0.3-17 mm) for MIBI- cancers (p = 0.03). Twenty-two percent of benign nodules were MIBI+ (22/101). Finally, the sensitivity, specificity, positive predictive value, and negative predictive value of MIBI were 61, 78, 50, and 85 %, respectively.
  
  
  CONCLUSIONS
  Thyroid nodules incidentally discovered on MIBI in hyperparathyroidism patients should be resected.
authors.affiliation: Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalier Universitaire (CHU) Nantes-Hôtel Dieu, Place Alexis Ricordeau, 44093, Nantes, France.
authors.forename: Tristan
authors.initials: T
authors.lastname: Greilsamer
authors.forename: Claire
authors.initials: C
authors.lastname: Blanchard
authors.forename: Niki
authors.initials: N
authors.lastname: Christou
authors.forename: Delphine
authors.initials: D
authors.lastname: Drui
authors.forename: Catherine
authors.initials: C
authors.lastname: Ansquer
authors.forename: Maelle
authors.initials: M
authors.lastname: Le Bras
authors.forename: Bertrand
authors.initials: B
authors.lastname: Cariou
authors.forename: Cécile
authors.initials: C
authors.lastname: Caillard
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Mourrain-Langlois
authors.forename: Anne Sophie
authors.initials: AS
authors.lastname: Delemazure
authors.forename: Muriel
authors.initials: M
authors.lastname: Mathonnet
authors.forename: Françoise
authors.initials: F
authors.lastname: Kraeber-Bodéré
authors.forename: Eric
authors.initials: E
authors.lastname: Mirallié
mesh_terms: D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging* / Q000601:surgery*; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000601:surgery*; D013965:Thyroidectomy; D014463:Ultrasonography
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi