Abstract
Objective: P-glycoprotein (P-gp) and multidrug resistance-associated protein (MRP) are membrane
efflux pumps that may have a role in the kinetics of 99mTc-sestamibi (MIBI) in parathyroid tumors. P-gp and MRP1 expression in parathyroid
tumors was studied and related to histology, weight and pre- and intraoperative MIBI
imaging results.
Design: Patient cohort study
Setting: Tertiary referral center
Patients: Thirty-three patients underwent radioguided parathyroidectomy for primary or secondary
hyperparathyroidism.
Main outcome measures: P-gp and MRP1 expression.
Methods: Dual-phase 99mTc-MIBI scintigraphy and SPECT results were compared to the surgical findings. Radioactivity
and weight of resected parathyroid tumors were measured. Intraoperative radioactivity
measurements were decay corrected. After routine histology immunohistochemistry was
performed using C494 monoclonal antibodies to P-gp and MRP1r1 to MRP1. P-gp and MRP1
expression were scored covering both distribution of positivity and degree of immunostaining
semi quantitatively.
Results: P-gp and MRP1 staining was observed in 97% and 43% of the glands respectively. P-gp
staining was positive in 91% (21/23) of the adenomas and in all 36 hyperplastic glands.
MRP1 staining was positive in 22% (5/23) of the adenomas and in 61% (22/36) of the
hyperplastic glands. P-gp or MRP1 expression did not correlate with preoperative 99mTc-MIBI imaging or intraoperative radioactivity. Parathyroid weight was associated
with preoperative MIBI imaging results and MIBI uptake measured during surgery.
Conclusion: P-gp and MRP1 expression did not correlate with 99mTc-MIBI uptake in parathyroid tumors. Parathyroid weight remains the major known factor
influencing 99mTc-MIBI uptake.
Key words
hypoparathyroidism - insufficiencies - hyperparathyroidism - Pgp
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Correspondence
J.T.M. PlukkerMD, PhD
Prof. of Surgery
Department of Surgical Oncology
University Medical Center Groningen
P.O. Box 30.001
9700 RB Groningen
The Netherlands
Telefon: 31/50/361 23 17
Fax: 31/50/361 48 73
eMail: j.th.plukker@chir.umcg.nl