Efficacy of Technetium Scintigraphy as an investigative Tool in Papillary Carcinoma of Thyroid: A Prospective Study

Abstract

ABSTRACT Introduction and background Thyromegaly is a common cause of physician consultation. Solitary thyroid nodules are conventionally viewed with suspicion. Clinical examination cannot reliably distinguish between a solitary thyroid nodule and a dominant nodule in multinodular goiter. Ultrasonographical examination has its own pitfalls. Technetium 99 is a commonly used modality for the functional assessment of solitary thyroid nodule detection. It has the advantage of low cost with lower radiation dose to the exposed patients. On literature search, studies on Technetium 99 scintigraphy for thyroid in context to the Indian scenario does not yield much information, and very few studies are notable. This study was conducted to correlate and qualify thyroid cold nodule as detected by technetium 99 pertechnetate thyroid scan. Objective This study was conducted to correlate, qualify, and compare the predictive value of technetium 99 pertechnetate scintigraphy on solitary thyroid nodule vis-à-vis fine needle aspiration cytology (FNAC) and to countercheck with histopathological examination (HPE). Materials and methods A prospective cohort study in a National Accreditation Board for Hospitals & Health care Providers, National Assessment and Accreditation Council, and Joint Commission International-accredited tertiary care teaching university hospital was conducted over a period of 36 months. All the subjects underwent clinical assessment of the neck that included standard examination techniques to segregate solitary thyroid nodules. They were then subjected to technetium 99 pertechnetate scintigraphy using the standard protocol. All the patients with solitary cold nodule underwent FNAC followed by nodule excision or hemi-thyroidectomy under general anesthesia. All the specimens underwent HPE by an experienced histopathologist. The results were statistically analyzed using Pearson's chi-square test. Results (1) Cold nodules as detected by technetium 99 pertechnetate thyroid scan is a reasonable indicator of probable malignancy vis-à-vis FNAC. (2) Occurrence of cold nodules is highest in third to fifth decade of life (21- to 50-year age group). (3) Occurrence of cold nodules is higher in females (83%), whereas occurrence of malignancy in cold nodules is higher in males (85%). (4) Occurrence of malignancy in cold nodules is higher in subjects less than 21 and above 50 years. (5) Technetium 99m pertechnetate thyroid scintigraphy is an important preoperative tool in management of thyroid nodules, and its routine use in all such patients is recommended, especially to rule out cold nodules. How to cite this article Mohanty S, Sreenivas C, Raj V, Efficacy of Technetium Scintigraphy as an investigative Tool in Papillary Carcinoma of Thyroid: A Prospective Study. Int J Head Neck Surg 2016;7(4):220-222.