Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism

Abstract

Objective: To evaluate the usefulness of the combination of 99m Tc-sestamibi/ 99m Tc-pertechnetate subtraction scintigraphy (SS) and high-resolution neck ultrasonography (US) in patients with primary hyperparathyroidism (pHPT) undergoing parathyroidectomy. Design and Methods: Ninety-one patients with proved pHPT were studied, excluding patients with persistent or recurrent disease. There were 65 (71.4%) women and 26 (28.6%) men, with a median age of 59 years (range 18±78 years). All patients underwent both SS and US prior to surgery, and the results were compared with operative and histological findings. The intraoperative quick-parathyroid hormone assay was available for 52 (57.1%) patients. When multiglandular disease was found, both SS and US were considered truly positive only when at least two enlarged parathyroid (PT) glands had been localized. Results: Eighty-three (91.2%) solitary PT adenomas and three (3.3%) carcinomas were found. Moreover, two (2.2%) patients had a double adenoma and three (3.3%) patients had diffuse PT hyperplasia. The overall sensitivity of combined SS US was 94.5% (86.8% and 80.4% for SS and US respectively). There was a significant P , 0X05Y Student's t-test) difference in size between the PT glands correctly identified and undetected by SS, whereas the site of the removed PT tumors significantly P , 0X05Y Fisher exact test) influenced only the US sensitivity. Conclusions: When the preoperative localization of the PT glands is chosen, the combination of SS and US represents a reliable noninvasive localization technique and should be considered for use in each patient with pHPT undergoing surgery.

Role of ultrasonography in the management of patients with primary hyperparathyroidism: retrospective comparison with technetium-99m sestamibi scintigraphy

“…The results of the statistical analysis of data from group C confirm the findings of numerous other studies [29][30][31][32], that is that preoperative use of ultrasound and scintigraphy in parallel improves accuracy in the detection and localization of single pathological parathyroid glands In fact, the use of both methods was associated with higher diagnostic sensitivity (87 %) than use of ultrasound (71 %) or scintigraphy (73 %) alone. We nonetheless feel that, as reported in previous studies, the inferior sensitivity of ultrasonography observed in Group C is due to the absence of dedicated physician sonographers and/or to the relative lack of experience of some of the examiners.…”

Robotic Transaxillary Parathyroid Surgery

“…Of these, USG, Tc-99m scintigraphy, and CT are the most commonly used methods [5]. On USG, a parathyroid adenoma typically appears hypoechoic, oval-shaped, and homogenous.…”

“…Fourdimensional computed tomography (4D-CT) is the most advanced of CT [6]. MIBI together with USG has a diagnostic sensitivity of 95% and is the most frequently used of the methods described above [5]. CT, PET, and selective venous sampling are rarely used in the reported literature.…”

Management of Primary Hyperparathyroidism

“…(Dimashkieh) Individually, sestamibi and US studies have limited accuracy, but the use of both imaging modalities increases the ability to successfully identify a single adenoma: the reported combined sensitivity is 95%. (Lumachi, 2000) When the results of both the sestamibi and US studies are concordant, the accuracy for identifying a single adenoma can be as high as 98%. (Haciyanli) Pros Cons…”

“…(Lumachi, 2000) It is also recommended for patients with familial PHPT; patients with multiple endocrine neoplasia syndrome type I and IIA; and patients who may have a carcinoma. In addition, it should be performed when a thyroid resection is planned concomitantly.…”