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Schenke SA, Campennì A, Tuncel M, Bottoni G, Sager S, Bogovic Crncic T, Rozic D, Görges R, Özcan PP, Groener D, Hautzel H, Klett R, Kreissl MC, Giovanella L. Diagnostic Performance of 99mTc-Methoxy-Isobuty-Isonitrile (MIBI) for Risk Stratification of Hypofunctioning Thyroid Nodules: A European Multicenter Study. Diagnostics (Basel) 2022; 12:diagnostics12061358. [PMID: 35741167 PMCID: PMC9221758 DOI: 10.3390/diagnostics12061358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
99mTc-MIBI (MIBI) imaging is able to exclude malignancy of hypofunctioning thyroid nodules (TNs) with high probability but false positive results are frequent due to low specificity. Therefore, pre-test selection of appropriate TNs is crucial. For image evaluation visual and semiquantitative methods (Washout index, WOInd) are used. Aim of this study was to evaluate the diagnostic performance of MIBI imaging in hypofunctioning TNs with indeterminate fine-needle aspiration cytology results in a multicentric European setting. Patients with hypofunctioning TNs, EU-TIRADS 4 or 5, Bethesda III/IV and MIBI imaging were included. For visual evaluation the intensity of MIBI uptake in the TN was compared to normal thyroid tissue. 358 patients with 365 TNs (n = 68 malignant) were included. Planar imaging (SPECT) showed a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 96% (94%), 21% (22%), 22% (15%), 96% (96%), and 35% (32%). The WOInd (38.9% of all cases, optimal cutoff: −19%) showed a sens 100% (spec 89%, PPV 82%, NPV 100%, ACC 93%). For hypofunctioning TNs at intermediate or high risk with indeterminate cytology, a MIBI negative result on visual evaluation is an effective tool to rule-out thyroid malignancy. The semi-quantitative method could considerably improve overall diagnostic performance of MIBI imaging.
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Affiliation(s)
- Simone Agnes Schenke
- Clinic of Nuclear Medicine Bayreuth Hospital, Preuschwitzer Straße 101, 95445 Bayreuth, Germany
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany;
- Correspondence:
| | - Alfredo Campennì
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Via Consolare Valeria, 98125 Messina, Italy;
| | - Murat Tuncel
- Department of Nuclear Medicine, Hacettepe University, Sihhiye, Ankara 06230, Turkey;
| | - Gianluca Bottoni
- Department of Nuclear Medicine, E.O. “Ospedali Galliera”, 16128 Genoa, Italy;
| | - Sait Sager
- Department of Nuclear Medicine, Medical Faculty, Istanbul University-Cerrahpaşa, Koca Mustafapasa Caddesi No: 53, Fatih, Istanbul 34096, Turkey;
| | - Tatjana Bogovic Crncic
- Department of Nuclear Medicine, Faculty of Medicine, University of Rijeka, Brace Branchetta 20/1, 51 000 Rijeka, Croatia;
| | - Damir Rozic
- Department of Nuclear Medicine, University Hospital Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina;
| | - Rainer Görges
- Department of Nuclear Medicine, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany;
| | - Pinar Pelin Özcan
- Department of Nuclear Medicine, University Hospital Mersin, Ciftlikkoy District, MEU Ciftlikkoy Campus, Yenisehir, Mersin 33110, Turkey;
| | - Daniel Groener
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany;
| | - Hubertus Hautzel
- Department of Nuclear Medicine, University Hospital Essen & German Cancer Consortium (DKTK), Hufelandstraße 55, 45147 Essen, Germany;
| | - Rigobert Klett
- Practice of Nuclear Medicine Hanau/Giessen/Frankfurt/Offenbach, Paul-Zipp-Straße 171, 35398 Giessen, Germany;
| | - Michael Christoph Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany;
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Via Officina 3, 6500 Bellinzona, Switzerland;
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Schenke SA, Campenni A, Tuncel M, Piccardo A, Sager S, Bogovic Crncic T, Rozic D, Goerges R, Özcan Kara PP, Groener D, Hautzel H, Klett R, Kreissl MC, Giovanella L. A multicenter survey of current practices of 99mTc-methoxy-isobutyl-isonitrile (MIBI) imaging for the diagnosis of thyroid nodules: more standardization is essential. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00439-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Purpose
Molecular imaging with 99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI, MIBI) has been used in the assessment of thyroid nodules (TNs) for more than two decades. Many studies showed that MIBI imaging is a suitable tool to rule-out malignancy when negative. However, relatively low specificity and accuracy have been described, thus, limiting its acceptance in clinical practice. Additionally, different technologies, protocols, and interpretation criteria are adopted accounting for heterogeneous data reported in the literature. Therefore, the present study was undertaken to assess the clinical use and methodology of MIBI imaging in patients with nodular thyroid disease in Europe.
Methods
A questionnaire was sent to 12 European centers of Nuclear Medicine. The questionnaire encompassed ultrasound (US) and fine-needle aspiration cytology (FNAC) procedures and their evaluation as well scintigraphy imaging indications, technical procedures, and interpretation criteria of MIBI imaging.
Results
The survey showed a good agreement of different centers in approaching TNs by TSH measurement, US evaluation and 99mTc-pertechnetate thyroid scintigraphy. MIBI imaging is mainly used to assess TNs with inconclusive/indeterminate cytological findings and selection of target nodule(s) for FNAC in patients with multi-nodular goiter. Technical procedures adopted in different centers are globally comparable and the recorded differences are unlikely to impact clinical results. However, as the main result of the present study, substantial differences were found in interpretation criteria adopted in different centers.
Conclusions
Our survey supports the urgent need of standardized interpretation criteria of thyroid MIBI imaging in order to improve its diagnostic performance and make results comparable in clinical practice.
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Crncic TB, Laskarin G, Frankovic KJ, Tokmadzic VS, Strbo N, Bedenicki I, Le Bouteiller P, Tabiasco J, Rukavina D. Early pregnancy decidual lymphocytes beside perforin use Fas ligand (FasL) mediated cytotoxicity. J Reprod Immunol 2006; 73:108-117. [PMID: 16950518 DOI: 10.1016/j.jri.2006.07.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 06/20/2006] [Accepted: 07/11/2006] [Indexed: 11/20/2022]
Abstract
Decidual natural killer (NK) cells are the predominant lymphocytes at the maternal-fetal interface. They are involved in defense against virally infected, parasitized and transformed cells and may contribute to the control of trophoblast invasion. The presence of perforin and other possible cytolytic mediators suggests these functions. Cytolytic mechanisms of unstimulated and Th1 cytokine stimulated decidual lymphocytes (DL), as well as purified decidual CD56(+) cells, were analyzed against NK sensitive and resistant targets. DL were isolated from decidual mononuclear cells (DMC) cultured in the medium only or in the presence of Th1 cytokines: IL-2, IL-12, IL-15, IL-18 and their combinations (IL-12/IL-18 or IL-15/IL-18). Fas ligand (FasL), perforin and granzyme B mRNAs expression and cytotoxicity were analyzed by flow cytometry and/or RT-PCR. DL (containing 72.19+/-7.53% of CD56(+) cells), obtained from 18h-cultured DMC in the medium only, expressed perforin, FasL and granzyme B mRNAs and lysed the NK-sensitive K-562 cell line, and also the NK-resistant P815 and P815-Fas transfected cell lines. Concanamycin A, a blocker of granule exocytosis, decreased significantly K-562 lysis, but not P815 lysis. However, the addition of anti-FasL antibody diminished significantly P815 lysis as well. IL-2 and IL-15, known inducers of perforin and FasL mRNAs and protein expression, could not additionally increase P 815 cell lysis by DL cultured within DMC. These results suggest that DL cultured in DMC for 18h, have the characteristics of lymphokine-activated killer (LAK) cells and are able to use efficiently both the perforin and the FasL cytolytic pathways.
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Affiliation(s)
- Tatjana Bogovic Crncic
- Department of Physiology and Immunology, Medical Faculty, University of Rijeka, B. Branchetta 20, HR-51000 Rijeka, Croatia
| | - Gordana Laskarin
- Department of Physiology and Immunology, Medical Faculty, University of Rijeka, B. Branchetta 20, HR-51000 Rijeka, Croatia
| | - Koraljka Juretic Frankovic
- Department of Physiology and Immunology, Medical Faculty, University of Rijeka, B. Branchetta 20, HR-51000 Rijeka, Croatia
| | - Vlatka Sotosek Tokmadzic
- Department of Physiology and Immunology, Medical Faculty, University of Rijeka, B. Branchetta 20, HR-51000 Rijeka, Croatia
| | - Natasa Strbo
- Department of Physiology and Immunology, Medical Faculty, University of Rijeka, B. Branchetta 20, HR-51000 Rijeka, Croatia
| | - Ivica Bedenicki
- Department of Physiology and Immunology, Medical Faculty, University of Rijeka, B. Branchetta 20, HR-51000 Rijeka, Croatia
| | | | | | - Daniel Rukavina
- Department of Physiology and Immunology, Medical Faculty, University of Rijeka, B. Branchetta 20, HR-51000 Rijeka, Croatia.
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Strbo N, Laskarin G, Bogovic Crncic T, Juretic Frankovic K, Bedenicki I, Sotosek Tokmadzic V, Randic L, Le Bouteiller P, Tabiasco J, Podack ER, Rukavina D. Short-term Cytolytic Mediators' Expression in Decidual Lymphocytes is Enhanced by Interleukin-15. Am J Reprod Immunol 2006; 55:217-25. [PMID: 16451356 DOI: 10.1111/j.1600-0897.2005.00351.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PROBLEM We investigated whether decidual adherent cells (DAC) and interleukin (IL)-15, in comparison to interleukin (IL)-2 affect cytolytic potential of first trimester decidual lymphocytes (DL). METHOD OF STUDY Decidual mononuclear cells were obtained by enzymatic digestion and density gradient centrifugation. Non-adherent DL were collected after 2-hr adherence and cultured for 18 or 72 hr with: IL-15 (0.5-5 ng/mL), IL-2 (100-1000 U/mL) or both of these cytokines, DAC (ratio 3:1 and 1:1) or DAC and anti-IL-15 antibody. Perforin, Fas ligand (FasL) and granzyme B were detected at mRNA level in indicated culture conditions. Cytolytic activity of DL against K-562, P815 and P815-Fas was measured by 2-hr PKH-26 cytotoxicity assay. The dynamics of perforin protein and mRNA expression were measured in DL after a contact with K-562 targets. RESULTS Interleukin-15 enhanced perforin, FasL and granzyme B transcription after 18-hr culture and prevented perforin protein downregulation, observed after DL culture. IL-2 had similar effects. DAC sustained perforin expression in DL and anti-IL-15 monoclonal antibody abrogated this effect. DAC increased cytotoxicity of DL against K-562 which was mediated by IL-15. CONCLUSION Interleukin-15, probably produced by DAC, upregulates cytolytic mediators' expression and perforin-mediated cytotoxicity of DL, with equal efficiency as high concentrations of IL-2.
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Affiliation(s)
- Natasa Strbo
- Department of Physiology and Immunology, Medical Faculty, University of Rijeka, Rijeka, Croatia
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Bogovic Crncic T, Laskarin G, Juretic K, Strbo N, Dupor J, Srsen S, Randic L, Le Bouteiller P, Tabiasco J, Rukavina D. Perforin and Fas/FasL Cytolytic Pathways at the Maternal-Fetal Interface. Am J Reprod Immunol 2005; 54:241-8. [PMID: 16212646 DOI: 10.1111/j.1600-0897.2005.00320.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The immunogenetic enigma of maternal acceptance of the fetal semiallograft has been termed an immunological paradox. The first trimester decidua is heavily infiltrated with CD56(bright) CD16- uterine natural killer (uNK) cells which must be prepared to respond to potential pathogen challenges and still be able to control immune responses that allow the development of the fetus. The significant presence of cytolytic mediators, perforin and Fas/Fas ligand (FasL), at the maternal-fetal interface raises a question of their role(s) in the immunological interrelations between maternal tissues and trophoblast cells. As uNK cells in vitro lyse target cell lines (K562, P815 and P815Fas) using these effector molecules, it seems that, although immunocompetent, their cytotoxicity is not directed against trophoblast during normal pregnancy. Therefore, it is generally believed that the hormonal and Th1/Th2 cytokine balance plays an important role in the tolerance and maintenance of pregnancy. This paper gives an overview of the recent findings on the complex immunological events that occur at the maternal-fetal interface.
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Affiliation(s)
- Tatjana Bogovic Crncic
- Department of Physiology and Immunology, Medical Faculty, University of Rijeka, Rijeka, Croatia
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Laskarin G, Strbo N, Crncic TB, Juretic K, Bataille NL, Chaouat G, Rukavina D. Physiological role of IL-15 and IL-18 at the maternal-fetal interface. Chem Immunol Allergy 2005; 89:10-25. [PMID: 16129949 DOI: 10.1159/000087906] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We review recent studies of two cytokines IL-15 and IL-18, showing that they are the critical cytokines controlling uterine NK cell cytokine production and cytolytic potential. Further, IL-15 has been implicated in differentiation and proliferation of uterine NK cells, while IL-18 enhanced innate immunity and both Th1- and Th2-driven immune responses depending on the cytokine milieu. We addressed the possible role of these two cytokines in induction of the IFN-gamma production as a key molecule in vascular remodeling during early pregnancy.
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Affiliation(s)
- Gordana Laskarin
- Department of Physiology and Immunology, Medical Faculty, University of Rijeka, Rijeka, Croatia
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Abstract
The conditions that permit the genetically distinct fetus to survive and develop within the mother are among the most fascinating immunologic puzzles. The presence of dendritic cells in the maternal decidua pointed to a biologic role of antigen-presenting cells in maternal-fetal interaction. The method of study included recent findings on the lineage, maturity, phenotype and function of dendritic cells at the maternal-fetal interface. The increment of uterine dendritic cells occurs simultaneously with the decisive phase of gestation, when implantation takes place. Decidual dendritic cells of the first trimester pregnancy, with a phenotype characteristic of the mature myeloid lineage, express MHC class II, co-stimulatory and adhesion molecules, control Th1/Th2 balance and activate the proliferative response of autologous NK cells. Dendritic cells are specifically equipped to control immunity, to trigger immune response and also to maintain tolerance, avoiding the rejection of the conceptus by the maternal immune system.
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Affiliation(s)
- Koraljka Juretic
- Department of Physiology and Immunology, Medical Faculty, University of Rijeka, Brace Branchetta 20, Rijeka 51 000, Croatia
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