Effectiveness of Surgeon Interpretation of Technetium Tc 99m Sestamibi Scans in Localizing Parathyroid Adenomas

Abstract

To evaluate the ability of surgeons to predict the laterality of parathyroid adenomas from technetium Tc 99m sestamibi scans and compare their results with the radiologic interpretations. Design: Retrospective medical record review with singleblinded review of sestamibi scans. Setting: Tertiary care academic medical center Patients: The study population included 110 consecutive parathyroidectomy cases from January 2001 to June 2004. Inclusion criteria were biochemically proven primary hyperparathyroidism, with documented serum hypercalcemia and elevated parathyroid hormone levels. Only cases due to a single adenoma that were cured with a single surgical procedure were included. Intervention: All patients underwent resection of a parathyroid adenoma following a preoperative sestamibi localization study and serum calcium and parathyroid hormone level analysis. Main Outcome Measure: Adenoma location was determined from a review of operative and pathological reports. Two head and neck surgeons performed a blinded review of all scans, and their findings were compared with the radiology reports.

Virtual Neck Exploration

“…After all, he is trained to interpret anatomic structures. 26 Concomitant thyroidectomy was necessary in 27 (23%) patients, indicating the special situation in an endemic goiter area, where localization of adenomas is rendered more difficult by coexisting thyroid nodules. 27 In 13 cases neither CT-MIBI image fusion nor MIBI-SPECT or CT gave a conclusive result.…”

CT-MIBI-SPECT image fusion predicts multiglandular disease in hyperparathyroidism

“…It is important to involve the surgeon into the interpretation of the imaging results because of his training in interpreting anatomic structures [19].…”

Current Concepts in the Presentation, Diagnosis and Management of Primary Hyperparathyroidism

“…These studies reported that surgeon interpretation and radiology experience increased the likelihood of localization [44,[45][46][47]. The authors recommend that sestamibi scans be reviewed by experienced parathyroid surgeons, rather than relying on radiological interpretation alone [45][46][47].…”

“…The authors recommend that sestamibi scans be reviewed by experienced parathyroid surgeons, rather than relying on radiological interpretation alone [45][46][47]. Anderson et al reported 62% sensitivity and 83% specificity of radiological interpretations [45]. Chen et al reported that the sensitivity of the surgeon (93%) was higher than both high-volume (83%) and low-volume (72%) radiologists [46].…”