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Basso C, Colapinto A, Vicennati V, Gambineri A, Pelusi C, Di Dalmazi G, Rizzini EL, Tabacchi E, Golemi A, Calderoni L, Fanti S, Pagotto U, Repaci A. Radioiodine whole body scan pitfalls in differentiated thyroid cancer. Endocrine 2024:10.1007/s12020-024-03754-y. [PMID: 38498129 DOI: 10.1007/s12020-024-03754-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE whole body scan (WBS) performed following diagnostic or therapeutic administration of I-131 is useful in patients with differentiated thyroid carcinoma. However, it can be falsely positive in various circumstances. We aimed to report a series of pitfalls in a clinical perspective. METHODS A search in the database PubMed utilizing the following terms: "false radioiodine uptake" and "false positive iodine 131 scan" has been made in January 2023. Among the 346 studies screened, 230 were included in this review, with a total of 370 cases collected. Physiological uptakes were excluded. For each patient, sex, age, dose of I-131 administered, region and specific organ of uptake and cause of false uptake were evaluated. RESULTS 370 cases of false radioiodine uptake were reported, 19.1% in the head-neck region, 34.2% in the chest, 14.8% in the abdomen, 20.8% in the pelvis, and 11.1% in the soft tissues and skeletal system. The origin of false radioiodine uptake was referred to non-tumoral diseases in 205/370 cases (55.1%), benign tumors in 108/370 cases (29.5%), malignant tumors in 25/370 cases (6.7%), and other causes in 32/370 cases (8.7%). CONCLUSIONS WBS is useful in the follow-up of patients with differentiated thyroid carcinoma, however it can be falsely positive in various circumstances. For this reason, it is critically important to correlate the scintigraphic result with patient's medical history, serum thyroglobulin levels, additional imaging studies and cytologic and/or histologic result.
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Affiliation(s)
- Cristina Basso
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandra Colapinto
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Valentina Vicennati
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandra Gambineri
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Carla Pelusi
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Guido Di Dalmazi
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Elisa Lodi Rizzini
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elena Tabacchi
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Arber Golemi
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Letizia Calderoni
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Uberto Pagotto
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Andrea Repaci
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
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Singhal T, Singh P, Parida GK, Kumar P, Patro SSP, Agrawal K. Aberrant Radioactive Iodine Uptake in Simple Ovarian Cyst: A Rare Finding. Indian J Nucl Med 2023; 38:387-389. [PMID: 38390537 PMCID: PMC10880847 DOI: 10.4103/ijnm.ijnm_115_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/06/2023] [Indexed: 02/24/2024] Open
Abstract
I-131 whole body scan and therapy play an important role in the follow-up of differentiated thyroid carcinoma patients for the detection of residual thyroid tissue and metastatic disease. However, various false-positive findings have been reported in the literature which can appear as metastases. Here, we present one such case, in which an I-131 posttherapy scan revealed false-positive radioactive iodine uptake which localized to a simple ovarian cyst.
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Affiliation(s)
- Tejasvini Singhal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Parneet Singh
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Girish Kumar Parida
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Pramit Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sai Sradha P Patro
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Kanhaiyalal Agrawal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Dabir M, Limberg J, Krieg A, Antke C, Sawicki LM. Radioiodine Uptake of a Benign Peritoneal Cyst on 131-I Whole-body Scan in a Patient Treated for Papillary Thyroid Cancer. Nuklearmedizin 2021; 61:130-131. [DOI: 10.1055/a-1699-1595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mardjan Dabir
- Department of Nuclear Medicine, University Hospital of Düsseldorf, Dusseldorf, Germany
| | - Juliane Limberg
- Institute of Pathology, University Hospital of Düsseldorf, Dusseldorf, Germany
| | - Andreas Krieg
- Department of Surgery (A), University Hospital of Düsseldorf, Dusseldorf, Germany
| | - Christina Antke
- Clinic of Nuclear Medicine, University Hospital of Düsseldorf, Dusseldorf, Germany
| | - Lino M. Sawicki
- Radiology, University Hospital of Düsseldorf, Dusseldorf, Germany
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Wu T, Zhao X, Xu H. False-Positive Radioiodine Uptake in Simple Ovarian Cyst in a DTC Patient: A Case Report. Front Oncol 2021; 11:665135. [PMID: 34136396 PMCID: PMC8200661 DOI: 10.3389/fonc.2021.665135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/11/2021] [Indexed: 11/13/2022] Open
Abstract
Abnormal radioildine uptake can be caused by various pelvic lesions in differentiated thyroid cancer patient. Here we presented an abnormal uptake in the left side of the pelvic cavity on postablative I-131 scintigraphy in a 51-year-old woman with history of stage T1aN1M0 papillary thyroid cancer. The SPECT/CT fused imaging revealed the lesion in the left ovary. Laparoscopic bilateral adnexectomy showed a left ovarian mass (5 cm) and pathologic finding showed a simple ovarian cyst. The nonstimulated Tg immediately decreased to 143 ng/ml after bilateral adnexectomy 3 days later and to 0.109 ng/ml after 4-month follow-up. Timely intervention measures are very necessary for patients with ovarian cyst with abnormally elevated Tg level.
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Affiliation(s)
- Tao Wu
- Department of Nuclear Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xuefeng Zhao
- Department of Nuclear Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Huiqin Xu
- Department of Nuclear Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Wu K, Ozomaro U, Flavell R, Pampaloni M, Liu C. Causes of False-Positive Radioactive Iodine Uptake in Patients with Differentiated Thyroid Cancer. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00381-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Purpose
Radioactive iodine (RAI) whole-body scan is a sensitive imaging modality routinely used in patients with differentiated thyroid cancer to detect persistent and recurrent disease. However, there can be false-positive RAI uptake that can lead to misdiagnosis and misclassification of a patient’s cancer stage. Recognizing the causes of false positivity can avoid unnecessary testing and treatment as well as emotional stress. In this review, we discuss causes and summarize various mechanisms for false-positive uptake.
Recent Findings
We report a patient with differentiated thyroid cancer who was found to have Mycobacterium avium complex infection as the cause of false-positive RAI uptake in the lungs. Using this case example, we discuss and summarize findings from the literature on etiologies of false-positive RAI uptake. We also supplement additional original images illustrating other examples of false RAI uptake.
Summary
False-positive RAI uptake may arise from different causes and RAI scans need to be interpreted in the context of the patient’s history and corresponding cross-sectional imaging findings on workup. Understanding the potential pitfalls of the RAI scan and the mechanisms underlying false uptake are vital in the care of patients with differentiated thyroid cancer.
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Chakraborty PP, Goswami S, Bhattacharjee R, Chowdhury S. Thyroid detectives: on the trail of Munchausen's syndrome. BMJ Case Rep 2019; 12:12/4/e226087. [PMID: 31036731 DOI: 10.1136/bcr-2018-226087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Thyrotoxicosis factitia, a disorder frequently seen in young or middle-aged women with psychological disorders, most commonly results from surreptitious ingestion of excess thyroid hormones. In most patients, diagnosis is relatively straightforward and depends on the demonstration of biochemical thyrotoxicosis, suppressed endogenous thyroid function and absence of clinical features of underlying thyroid disease. However, at times, confounding factors can make the diagnosis particularly challenging and necessitate the investigating physician to don the detective's cap to get to the root of the problem. We discuss a patient whose diagnosis was reached with ingenuity after considerable effort from four endocrinologists having a total experience of 37 years in their field.
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Affiliation(s)
| | - Soumik Goswami
- Endocrinology, Nil Ratan Sircar Medical College, Kolkata, West Bengal, India
| | - Rana Bhattacharjee
- Endocrinology and Metabolism, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Endocrinology and Metabolism, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India
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Variable 131I Activity in Multiple Hepatic Cysts in a Patient With Thyroid Cancer. Clin Nucl Med 2019; 44:324-326. [DOI: 10.1097/rlu.0000000000002442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Increased 131I Accumulation in the Gallbladder and High-grade Serous Ovarian Adenocarcinoma. Clin Nucl Med 2019; 44:61-63. [DOI: 10.1097/rlu.0000000000002339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Oral A, Yazıcı B, Eraslan C, Burak Z. Unexpected False-positive I-131 Uptake in Patients with Differentiated Thyroid Carcinoma. Mol Imaging Radionucl Ther 2018; 27:99-106. [PMID: 30317832 PMCID: PMC6191736 DOI: 10.4274/mirt.37450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Radioiodine is the most specific radionuclide for differentiated thyroid carcinoma (DTC) imaging. Despite its high specificity and sensitivity, false-positive I-131 uptake could be seen on whole body scan (WBS) that may lead to misdiagnosis and unnecessary radioiodine treatment. In this study, we aimed to present the I-131 WBS and concomitant single photon emission computed tomography/computed tomography (SPECT/CT) images of unexpected false-positive radioiodine uptake along with the patients’ clinical outcomes and the contribution of SPECT/CT imaging. Methods: I-131 WBSs of 1507 patients with DTC were retrospectively reviewed, and anticipated I-131 uptakes (like in breasts or thymus) were excluded from the study. The unexpected false-positive I-131 uptakes with concomitant SPECT/CT imaging were included in the study. Results: Twenty-one patients had 23 unexpected I-131 uptakes on WBS and concomitant SPECT/CT imaging. The vast majority (87%) of these cases were seen on post-therapeutic I-131 WBS. Most of the false-positive I-131 uptakes could be explained by SPECT/CT and radiologic findings, and were secondary to non-thyroid conditions (bronchiectasis, lung infection, subcutaneous injection into gluteal fatty tissue, aortic calcification, benign bone cyst, vertebral hemangioma, recent non-thyroid surgical procedure site, rotator cuff injury, mature cystic teratoma and ovarian follicle cyst). However, the possible reasons of 9 false-positive I-131 uptakes could not be explained by radiologic findings. Conclusion: We suggest that false-positive I-131 uptake and its underlying mechanisms (inflammation, trapping, increased perfusion, etc.) must be kept in mind in patients with thyroid cancer and unexpected findings must be considered together with serum thyroglobulin levels, SPECT/CT and radiologic findings in order to avoid misdiagnosis and unnecessary radioiodine treatment.
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Affiliation(s)
- Aylin Oral
- Ege University Faculty of Medicine, Department of Nuclear Medicine, İzmir, Turkey
| | - Bülent Yazıcı
- Ege University Faculty of Medicine, Department of Nuclear Medicine, İzmir, Turkey
| | - Cenk Eraslan
- Ege University Faculty of Medicine, Department of Radiology, İzmir, Turkey
| | - Zeynep Burak
- Ege University Faculty of Medicine, Department of Nuclear Medicine, İzmir, Turkey
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Dehal HK, Cardenas SC, Patel P, Thomas A. Radioiodine uptake in A Renal CYST in A Patient with Papillary Thyroid Carcinoma. AACE Clin Case Rep 2018. [DOI: 10.4158/ep161722.cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Chudgar AV, Shah JC. Pictorial Review of False-Positive Results on Radioiodine Scintigrams of Patients with Differentiated Thyroid Cancer. Radiographics 2017; 37:298-315. [PMID: 28076008 DOI: 10.1148/rg.2017160074] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Radioiodine has served an important role in the diagnostic workup and treatment of patients with differentiated thyroid cancer for more than 6 decades. The interpretation of radioiodine scintigraphic studies should be performed in conjunction with a comprehensive history, histopathologic correlation, and pertinent laboratory values, as well as correlation with available anatomic images and the findings from physical examination. A thorough understanding of the physiology and biodistribution of radioiodine is critical when interpreting radioiodine scintigraphic studies to avoid misinterpretation of physiologic and nonthyroid pathologic variants as thyroid cancer metastases. Differentiating a false-positive finding from a true metastasis on pretherapy radioiodine scintigrams is important to determine the appropriate radioiodine treatment dose. The correct interpretation of posttherapy radioiodine scintigraphic studies is also important to determine if repeat radioiodine treatment will be necessary and for the future clinical and imaging followup of the patient. A variety of different factors, such as the presence of the sodium-iodide symporter and the passive diffusion or retention of radioiodine in normal and pathologic structures, can result in false-positive results on radioiodine scintigrams. Numerous false-positive findings have been reported in the literature and are further demonstrated with the increasing availability of single photon emission computed tomography (SPECT) integrated with computed tomography (CT) as true dual-modality imaging (SPECT/CT). SPECT/CT has been documented to be of incremental value in the accurate anatomic localization and characterization of radioiodine uptake as false-positive findings, particularly in cases with discordant findings of a low serum thyroglobulin level but positive findings on radioiodine whole-body planar scintigrams. The objectives of this review are to describe the physiology and biodistribution of radioiodine and to provide examples of false-positive results on radioiodine scintigrams, with clinical and anatomic correlation, in the following categories of radioiodine uptake: functional uptake secondary to sodium-iodide symporter expression, radioiodine retention, nonthyroid neoplasms, inflammatory or infectious uptake, contamination, and other causes. ©RSNA, 2017.
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Affiliation(s)
- Amy V Chudgar
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Pennsylvania, Perelman School of Medicine, 3400 Spruce St, Donner 110-A, Philadelphia, PA 19104
| | - Jagruti C Shah
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Pennsylvania, Perelman School of Medicine, 3400 Spruce St, Donner 110-A, Philadelphia, PA 19104
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Kargar S, Shiryazdi SM, Atashi SR, Neamatzadeh H, Kamali M. Urinary Iodine Concentrations in Cancer Patients. Asian Pac J Cancer Prev 2017; 18:819-821. [PMID: 28441792 PMCID: PMC5464505 DOI: 10.22034/apjcp.2017.18.3.819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: It has been suggested that incidence of some cancers, especially examples in the breast and stomach
may be influenced by the iodine intake. However, only few studies are available at present. Therefore, we have conducted
the present assessment of iodine status in Iranian patients diagnosed with a malignancy. Materials and Methods:
This cross-sectional study was conducted in 85 patients diagnosed with different types of cancer at Shahid Sadoughi
Hospital, Yazd, Iran. The method used was based on the Sandell–Kolthoff reaction. Results: The median urinary iodine
concentration (UIC) was 17.4 μg/L, with ≤20 μg/L indicative of severe iodine deficiency. According to the WHO/IC C
IDD/UNIC EF classification, 88.1%, 7.1% and 2.4% of patients had a UIC <20 (severe), 20–49 (mild), and 50–99 μg/L
(moderate), respectively. There was no statistically significant differences in UIC between men and women. Conclusion:
The UIC values indicate that Iranian cancer patients were seriously iodine deficient according to WHO/UNIC EF/
IC C IDD, and that this is a suitable index to assess iodine status in Iranians. Daily consumption of salt fortified with
iodine or other approaches to increase intake might be effective strategies for prevention or reduction of malignancies.
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Affiliation(s)
- Saeed Kargar
- Department of General Surgery, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Ranade R, Pawar S, Mahajan A, Basu S. Unusual False Positive Radioiodine Uptake on (131)I Whole Body Scintigraphy in Three Unrelated Organs with Different Pathologies in Patients of Differentiated Thyroid Carcinoma: A Case Series. World J Nucl Med 2016; 15:137-41. [PMID: 27134566 PMCID: PMC4809156 DOI: 10.4103/1450-1147.176884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Three cases with unusual false positive radioiodine uptake in three different organs and pathologies (infective old fibrotic lesion in the lung, simple liver cyst, and benign breast lesion) on iodine-131 (131I) whole body scintigraphy. Clinicoradiological correlation was undertaken in all three cases and the pathologies were ascertained. In all the three cases, single-photon emission computerized tomography-computed tomography (SPECT-CT) and ancillary imaging modalities were employed and were helpful in arriving at the final diagnosis.
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Affiliation(s)
- Rohit Ranade
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Mumbai, Maharashtra, India
| | - Shwetal Pawar
- Department of Nuclear Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Abhishek Mahajan
- Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Mumbai, Maharashtra, India
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Unusual Uptake of Radioiodine in a Retroperitoneal Bronchogenic Cyst in a Patient With Thyroid Carcinoma. Clin Nucl Med 2015; 40:435-6. [PMID: 25546201 DOI: 10.1097/rlu.0000000000000664] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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