Assadi, M

Kalantarhormozi, M

Nabipour, I

Bushehr University of Medical Sciences Repository

AJR:207, August 2016 W21LettersAJR 2016; 207:W21 0361–803X/16/2072–W21 © American Roentgen Ray SocietyThyroid Nodule Characterization Using Combined Fine-Needle Aspiration and 99mTc-Sestamibi Scintigraphy StrategyIn the February 2016 issue of the AJR, Yerubandi et al. [1] wrote an interesting article on the frequency of thyroid nodules observed incidentally on non–FDG PET nuclear medi-cine imaging modalities, including 99mTc-sestamibi radiotracer, the malignancy rate of such nodules, and predictors of malignancy.To further expand on this point, it has been shown that fine-needle aspiration (FNA) combined with 99mTc-sestamibi scin-tigraphy for evaluating cold thyroid nodules larger than 1 cm in diameter is potentially cost-effective in the management of solitary or dominant thyroid nodules [2]. Sestamibi-based strategies have a lower cost per patient and lower cost per cancer diagnosed and are associated with a low radiation burden [2].We have observed several cases of discrep-ancies between FNA cytology and 99mTc-ses-tamibi scintigraphy results in our practice, which has evaluated more than 1000 cases to date [3, 4] (Fig. 1). Such cases illustrate the potential complexity of diagnosing thyroid nodules, and strategies combining FNA with 99mTc-sestamibi scintigraphy may also end in diagnostic dilemmas.The discrepancies and dilemmas described here illustrate the need for a pragmatic ap-proach to training medical practitioners so that they may adapt their treatment strategies for patients with cold thyroid nodules.Iraj NabipourBushehr Medical University Hospital, Bushehr University of Medical Sciences,Bushehr, IranMohammadreza KalantarhormoziPersian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, IranMajid AssadiPersian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences,Bushehr Medical University Hospital,Bushehr, IranDOI:10.2214/AJR.16.16163WEB—This is a web exclusive article.References 1. Yerubandi V, Chin BB, Sosa JA, Hoang JK. Inci-dental thyroid nodules at non–FDG PET nuclear medicine imaging: evaluation of prevalence and malignancy rate. AJR 2016; 206:420–425 2. Wale A, Miles KA, Young B, et al. Combined 99mTc-methoxyisobutylisonitrile scintigraphy and fine-nee-dle aspiration cytology offers an accurate and poten-tially cost-effective investigative strategy for the assessment of solitary or dominant thyroid nodules. Eur J Nucl Med Mol Imaging 2014; 41:105–115 3. Riazi A, Kalantarhormozi MR, Nabipour I, et al. Technetium-99m methoxyisobutylisonitrile scin-tigraphy in the assessment of cold thyroid nod-ules: is it time to change the approach to the man-agement of cold thyroid nodules? Nucl Med Commun 2014; 35:51–57 4. Riazi A, Kalantarhormozi M, Nabipour I, Ostovar A, Javadi H, Assadi M. Comments on Wale et al.: Combined 99mTc-methoxyisobutylisonitrile scin-tigraphy and fine-needle aspiration cytology of-fers an accurate and potentially cost-effective in-vestigative strategy for the assessment of solitary or dominant thyroid nodules. (letter) Eur J Nucl Med Mol Imaging 2014; 41:575–576Fig. 1—39-year-old woman with cold thyroid nodule. Scintigraphy with 99mTc-pertechnetate (left) shows nodule on left lobe of thyroid gland. Nodule shows significant radiotracer retention with poor washout (arrow), which is also seen on sestamibi scan (right). Fine-needle aspiration cytology findings showed nodular goiter, but histopathologic examination showed medullary thyroid carcinoma 4 mm in diameter.Downloaded from www.ajronline.org by Weill Med. College on 08/03/16 from IP address 207.162.240.147. Copyright ARRS. For personal use only; all rights reserved 

Thyroid Nodule Characterization Using Combined Fine-Needle Aspiration and (99m)Tc-Sestamibi Scintigraphy Strategy.

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Thyroid Nodule Characterization Using Combined Fine-Needle Aspiration and (99m)Tc-Sestamibi Scintigraphy Strategy.

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