A prospective evaluation of preoperative localization by technetium-99m sestamibi scintigraphy and ultrasonography in primary hyperparathyroidism

Abstract Background Ultrasonography (USG) and technetium-99m sestamibi (MIBI) scintigraphy are commonly used imaging modalities in the era of minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism (pHPT). However, their relative importance and actual contribution to MIP have not...

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Bibliographic Details
Published in:The American journal of surgery 2007-02, Vol.193 (2), p.155-159
Main Authors: Lo, Chung-Yau, M.S. (H.K.), F.R.C.S. (Edin), F.A.C.S, Lang, Brian H., M.S. (H.K.), M.R.C.S. (Edin), F.R.A.C.S, Chan, W.F., M.B.B.S. (H.K.), F.R.C.S. (Edin), Kung, Annie W.C., M.D. (H.K.), F.R.C.P, Lam, Karen S.L., M.D., F.R.C.P
Format: Article
Language:English
Subjects:
Accuracy
Adenoma - diagnostic imaging
Adenoma - surgery
Adolescent
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Endocrine system
Endocrinopathies
Female
General aspects
Hormones
Humans
Hyperparathyroidism, Primary - etiology
Hyperplasia
Male
Medical imaging
Medical sciences
Middle Aged
Minimally invasive parathyroidectomy
Non tumoral diseases. Target tissue resistance. Benign neoplasms
Nuclear medicine
Organ Size
Parathyroid adenoma
Parathyroid Diseases - diagnostic imaging
Parathyroid Diseases - surgery
Parathyroid Glands - pathology
Parathyroid Neoplasms - diagnostic imaging
Parathyroid Neoplasms - surgery
Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases)
Patients
Preoperative Care
Primary hyperparathyroidism
Prospective Studies
Radionuclide Imaging
Sensitivity and Specificity
Surgery
Tc 99m-Sestamibi scintigraphy
Technetium Tc 99m Sestamibi
Ultrasonography
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Summary:Abstract Background Ultrasonography (USG) and technetium-99m sestamibi (MIBI) scintigraphy are commonly used imaging modalities in the era of minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism (pHPT). However, their relative importance and actual contribution to MIP have not been prospectively assessed. Methods A total of 100 consecutive pHPT patients planning for MIP were recruited. Both USG and MIBI findings were correlated with intraoperative findings and postoperative outcome. Clinicopathologic factors were examined for potential association with a correct localizing result. Results Thirty men and 70 women (age range 13 to 93 years [median 55.5]) were included in the study. The final pathology included 98 patients with solitary adenoma and 2 patients with multiglandular disease. The sensitivities, accuracies, and positive predicted values for USG and MIBI alone were 57% vs 89%, 56% vs 85%, and 97% vs 94%, respectively. Correctly localized adenomas were significantly heavier than incorrectly localized ones. Conclusions MIBI is preferred over USG in pHPT patients planning for MIP. Weight of adenoma appeared to be the only clinicopathologic factor determining localization accuracy.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2006.04.020