Determinants of Tc-99m sestamibi SPECT scan sensitivity in primary hyperparathyroidism

Swanson, Todd; Chan, Simon K.; Jones, Steven J.M.; Bugis, Samuel P.; Irvine, Robert; Belzberg, Allan S.; Levine, Daniel S.; Wiseman, Sam M.

doi:10.1016/j.amjsurg.2010.02.001

Cited by 32 publications

(14 citation statements)

References 22 publications

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“…With these parameters, the spillover is lower than 1% in 123 I window and 10% in 99m Tc window. 13 Hindié et al 7 have used wider symmetrical window for 99m Tc (T7.5%) and asymmetrical window (range, 4% to +10%) for 123 I, which could also account for high sensitivity reported.…”

Section: Impact Of Collimationmentioning

confidence: 95%

“…Lesser sensitivity of scintigraphy for small enlarged gland is well known with 99m Tc-MIBI 13 and with dual-isotope 14 in planar and tomographic images. 8 In our study, scintigraphy was negative with the 2 protocols for 3 patients; the adenomas had small volume, inferior to 3.7 cm 3 (mean for all enlarged parathyroid is 9 cm 3 ).…”

Section: Impact Of Parathyroid Gland Volumementioning

confidence: 97%

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Dual-Isotope 99mTc-MIBI/123I Parathyroid Scintigraphy in Primary Hyperparathyroidism

Hassler¹,

Ben-Sellem²,

Hubelé³

et al. 2014

Clinical Nuclear Medicine

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Section: Impact Of Collimationmentioning

confidence: 95%

Section: Impact Of Parathyroid Gland Volumementioning

confidence: 97%

Dual-Isotope 99mTc-MIBI/123I Parathyroid Scintigraphy in Primary Hyperparathyroidism

Hassler¹,

Ben-Sellem²,

Hubelé³

et al. 2014

Clinical Nuclear Medicine

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“…17 The scan results are dependent on the size of the lesion and calcium levels. 18 US is a cheap, convenient and non-invasive modality that has a sensitivity of 73% and a positive predictive value of 100% in single parathyroid adenomas. 19 In competent hands, US is capable of providing precise anatomical detail that corresponds closely to surgical findings 92% of the time.…”

mentioning

confidence: 99%

Simplified minimally invasive parathyroidectomy: a series of 100 cases and review of the literature

Wong

et al. 2011

annals

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Primary hyperparathyroidism (PHPT) is defined as symptomatic hypercalcaemia due to excessive parathyroid hormone (PTH) secretion in the absence of secondary or tertiary causes. Surgical management involves parathyroidectomy, which has shown to improve health-related quality of life.1 Conventional surgical practice has been collar incision with bilateral neck exploration and a four-gland evaluation approach.From the early 21st century, minimally invasive techniques of unilateral exploration and evaluation limited to the site of suspected lesion, as directed by preoperative localisation, were developed.2 These include video-assisted parathyroidectomy, endoscopic parathyroidectomy and mini-incision parathyroidectomy.Minimally invasive parathyroidectomy (MIP) showed a lower complication rate, with a reduced hospital stay and cost compared with the conventional approach.3 However, a national survey in the UK and Ireland noted that only 3% of consultant members of the British Association of Endocrine Surgeons were using the lateral incision approach, with the majority preferring the collar incision. 4 Some centres use intraoperative parathyroid hormone (IOPTH) measurements as routine 5 although the role of the IOPTH in parathyroidectomy at this point is questionable. 6Frozen sections are also used occasionally in parathyroid surgery to identify parathyroid tissue and differentiate it from non-parathyroid tissue with good accuracy. 7Our local practice utilises simplified parathyroidectomy. This involves a mini-incision without the routine use of IOPTH measurements and frozen sections. This study aims to demonstrate that a good success rate can be achieved without the use of any intraoperative adjuncts. This simplified technique will hopefully encourage more to undertake minimally invasive parathyroid surgery. Materials and MethodsThe first 100 patients who underwent MIP for PHPT from January 2008 done at a single institution by a single surgeon were recruited prospectively for this study. Preoperatively, patients underwent ultrasonography (US) and/or a 99m Tc-labelled sestamibi (MIBI) scan for localisation. The risks were ABSTRACT inTRodUCTion Conventional practice of parathyroidectomy has been collar incision with bilateral neck exploration and a fourgland evaluation. our local practice involves simplified parathyroidectomy via mini-incision without routine use of intraoperative adjuncts. The aim of this study is to demonstrate that a good success rate can be achieved, which will hopefully encourage more to undertake minimally invasive parathyroid surgery. maTERiaLS and mEThodS a prospective case series of the first 100 patients undergoing minimally invasive parathyroidectomy (miP) by a single surgeon at a single institution were included. Preoperatively, patients underwent ultrasonography (US) and/or a sestamibi (mibi) scan for localisation. Parathyroidectomy was performed following an algorithm of intraoperative decisions. Serum calcium and/or parathyroid hormone levels were checked at follow-up. Postoperative normo...

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“…However, there was poor agreement between the 2 studies in the localization of parathyroid adenoma (Table 4). Varied sensitivity of Tc 99m MIBI for parathyroid adenoma has been reported in previous studies, including 56% in 1 study [15] 45% in another [16] and 39% to 90% in a large meta-analysis of 52 studies [16]. Another study reported 90% sensitivity and 91% accuracy [17].…”

Section: Discussionmentioning

confidence: 86%

MIBI SPECT Scan and Ultrasonography in Preoperative Imaging of Primary Hyperparathyroidism

Batawil¹

2015

OMICS J Radiol

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Objectives: In patients who have parathyroid adenoma, combination of ultrasonography and technetium Tc 99m sestamethoxyisobutylisonitrile scan (also called sestamibi or MIBI scan), which allows anatomic and functional information about parathyroid adenomas, is used commonly to maximize operative cure. The sensitivity of MIBI scan may be increased by adding single photon emission computed tomography (SPECT) and computed tomography (CT) as a combined MIBI-SPECT CT scan. We assessed the accuracy of ultrasonography and parathyroid MIBI-SPECT scan in detecting parathyroid adenoma and evaluated the potential benefit of the combined protocol of ultrasonography and MIBI-SPECT parathyroid scan. Methods:In 58 patients who had biochemical evidence of primary hyperparathyroidism, we retrospectively reviewed the preoperative ultrasonography and MIBI-SPECT scans. The results of these studies were correlated with surgical findings. Results:In the 58 patients, surgery showed that 43 patients (74%) had solitary parathyroid adenoma. The sensitivity, specificity and accuracy of MIBI-SPECT for parathyroid adenoma was (72%,80%,74%) and for ultrasonography (53%,60%,55%) respectively. The highest sensitivity is noted with the combination of MIBI-SPECT and ultrasonography (79%), . 9 adenomas (21%) were missed by both modalities. In the 20 adenomas that were missed by ultrasound 11 were detected by MIBI SPECT. Conclusion:The MIBI-SPECT had better performance than ultrasonography for parathyroid adenoma localization. The combined MIBI SPECT and ultrasonography has the highest sensitivity for parathyroid adenoma detection (79%). An alternative strategy may be to use MIBI-SPECT initially, and to proceed to ultrasonography only in patients with negative MIBI-SPECT. This may avoid many ultrasonography procedures.

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Determinants of Tc-99m sestamibi SPECT scan sensitivity in primary hyperparathyroidism

Cited by 32 publications

References 22 publications

Dual-Isotope 99mTc-MIBI/123I Parathyroid Scintigraphy in Primary Hyperparathyroidism

Dual-Isotope 99mTc-MIBI/123I Parathyroid Scintigraphy in Primary Hyperparathyroidism

Simplified minimally invasive parathyroidectomy: a series of 100 cases and review of the literature

MIBI SPECT Scan and Ultrasonography in Preoperative Imaging of Primary Hyperparathyroidism

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