Journal Article

A Comprehensive Diagnostic Assessment of Thyroid Nodules Utilizing Scintigraphy and Telomere Lengths ile Kapsamli Tanisal Degerlendirmesi

Silan, Fatma, Ozdemir, Semra Usta, Karakilic, Ersen, Ozturk, Fulya Kog

2025

Overview

Objectives: This study aims to evaluate the effectiveness and role of telomere length measurements in leukocytes, plasma free cell DNA (cfDNA), and biopsy cells, along with technetium-99m (Tc-99m) methoxyisobutylisonitrile (MIBI) scintigraphy, as non-invasive methods for diagnosing malignant thyroid lesions. Methods: Data from 128 patients, who underwent ultrasound, Tc-99m MIBI scintigraphy, and fine-needle biopsy with a preliminary diagnosis of malignant thyroid nodules, were analyzed. In 98 patients, telomere lengths in leukocytes (from blood), cfDNA (from plasma), and biopsy cells were measured using the quantitative polymerase chain reaction method, and the relative telomere/single copy gene (T/S) ratio was calculated. Based on cytological examination results, patients were categorized into three groups: malignant, benign, and suspicious. Group differences were analyzed using the Kruskal-Wallis and Chi-square tests, and correlations between variables were examined with Spearman correlation analysis. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of Tc-99m MIBI scintigraphy for diagnosing malignant thyroid nodules were 64.70%, 79.16%, 29.72%, 83.51%, and 67.96%, respectively. While these results align with the literature, the positive predictive value was notably lower. No significant differences were observed in telomere lengths (T/S ratios) in leukocytes, plasma, or tissue between the groups. Conclusion: Tc-99m MIBI scintigraphy demonstrates reasonable diagnostic accuracy for identifying malignancy in thyroid nodules. Contrary to limited reports, telomere length measurements may not be a reliable method for predicting thyroid malignancy. Larger studies are needed to further explore these findings. Keywords: Thyroid cancer, technetium-99m methoxyisobutylisonitrile scintigraphy, cell DNA, liquid biopsy, circulating tumor DNA, telomere Ama : Bu alisma, l kositlerde, plazma serbest h cre DNA'sinda (cfDNA) ve biyopsi h crelerinde telomer uzunlugu l mleri ile teknesyum-99m (Tc-99m) metoksiizob tilizonitril (MIBI) sintigrafisinin, k t huylu tiroid lezyonlarinin teshisinde non-invaziv y ntemler olarak etkinligini ve rol n degerlendirmeyi ama lamaktadir. Y ntem: Malign tiroid nod lleri n tanisi konulan ve ultrason, Tc-99m MIBI sintigrafisi ve ince igne biyopsisi uygulanan 128 hastanin verileri analiz edilmistir. Doksan sekiz hastada, l kositlerde (kandan), cfDNA'da (plazmadan) ve biyopsi h crelerinde telomer uzunluklari kantitatif polimeraz zincir reaksiyonu y ntemiyle l lm s ve g receli telomer/tek kopya gen (T/S) orani hesaplanmistir. Sitolojik inceleme sonu larina g re hastalar; k t huylu, iyi huylu ve s pheli olmak zere gruba ayrilmistir. Gruplar arasi farklar Kruskal-Wallis ve ki-kare testleriyle analiz edilmis, degiskenler arasindaki korelasyonlar Spearman korelasyon analizi ile degerlendirilmistir. Bulgular: Tc-99m MIBI sintigrafisinin k t huylu tiroid nod llerini teshis etmedeki duyarlilik, zg ll k, pozitif ng r degeri, negatif ng r degeri ve dogruluk oranlari sirasiyla %64,70, %79,16, %29,72, %83,51 ve %67,96 olarak bulunmustur. Bu sonu lar literat rle uyumlu olmakla birlikte, pozitif ng r degerinin belirgin sekilde d s k oldugu g zlemlenmistir. L kosit, plazma veya doku rneklerindeki telomer uzunluklari (T/S oranlari) a isindan gruplar arasinda anlamli bir fark bulunmamistir. Sonu : Tc-99m MIBI sintigrafisi, tiroid nod llerinde malignitenin tespitinde makul bir tanisal dogruluk sunmaktadir. Ancak sinirli raporlara ragmen, telomer uzunlugu l mlerinin tiroid malignitesini ng rmede g venilir bir y ntem olmayabilecegi anlasilmaktadir. Bu bulgularin daha kapsamli alismalarla arastirilmasi gerekmektedir. Anahtar kelimeler: Tiroid kanseri, teknesyum-99m metoksi izob tilizonitril sintigrafi, h cre DNA'si, sivi biyopsi, dolasan t m r DNA'si, telomer

• Publisher: Galenos Yayinevi Tic. Ltd
• Subject: Diagnosis / Evaluation / Health aspects / Methods / Radioisotope scanning / Telomeres / Thyroid diseases