Preoperative parathyroid localization with sestamibi

Malhotra, Ajai K.; Silver, Carl E.; Deshpande, V.K.; Freeman, Leonărd M.

doi:10.1016/s0002-9610(96)00289-9

Cited by 51 publications

(28 citation statements)

References 7 publications

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“…In patients with hyperplastic parathyroid glands sensitivity of preoperative localization procedures ranges between 41 and 62%, but the frequency of multiglandular disease is less than 15% (Malhotra et al 1996, Molinari et al 1996, Blanco et al 1998, Pattou et al 1999. It has also been suggested that MPS imaging can help to distinguish preoperatively hyperplasia from adenomatous disease (Johnston et al 1996).…”

Section: Discussionmentioning

confidence: 99%

Localization of parathyroid tumours in the minimally invasive era: which technique should be chosen? Population-based analysis of 253 patients undergoing parathyroidectomy and factors affecting parathyroid gland detection.

Lumachi¹,

Ermani²,

Basso³

et al. 2001

Endocrine-Related Cancer

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A series of 253 consecutive patients with proved primary hyperparathyroidism due to parathyroid tumours was reviewed. There were 68 (26.9%) men and 185 (73.1%) women, with a median age of 57 years (range 13-82 years). All patients, prior to successful parathyroidectomy, underwent one or more preoperative localization procedures such as: neck ultrasonography (US) in 191 (75.5%), 201 Tl/ 99m Tc-pertechnetate subtraction scintigraphy (TPS) in 144 (56.9%), CT scan in 92 (36.4%), 99m Tc-sestamibi/ 99m Tc-pertechnetate subtraction scintigraphy (MPS) in 90 (35.6%), selective venous sampling (SVS) with parathyroid hormone (PTH) assay in 30 (11.9%), and magnetic resonance imaging (MRI) in 6 (2.4%) patients. The results were compared with operative and histological findings that showed 235 (92.9%) solitary parathyroid adenomas, 13 (5.1%) carcinomas and 5 (2.0%) double adenomas. Sensitivity and positive predictive value were 82.9% and 93.8% for US, 83.6% and 91.8% for TPS, 81.3% and 98.7% for CT scan, 85.1% and 96.1% for MPS, 65.4% and 80.9% for SVS, and 80.0% and 80.0% for MRI respectively. No different results (P = NS) were found using US, TPS, MPS or CT scan, whereas SVS and MRI sensitivity was lower (P < 0.05). The combination of MPS and US was 94.0% sensitive (P < 0.05) but when TPS, CT scan or MRI were also used overall sensitivity did not improve significantly (P = NS). In conclusion, MPS should be used as the starting preoperative localization procedure, while US and MPS together represent the most reliable noninvasive localization tool. If MPS and US are negative or not in agreement, further studies are not cost-effective and the patient should undergo bilateral neck exploration.

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Section: Discussionmentioning

confidence: 99%

Localization of parathyroid tumours in the minimally invasive era: which technique should be chosen? Population-based analysis of 253 patients undergoing parathyroidectomy and factors affecting parathyroid gland detection.

Lumachi¹,

Ermani²,

Basso³

et al. 2001

Endocrine-Related Cancer

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“…Estes pacientes apresentavam, possivelmente, hiperparatiroidismo secundário com hiperplasia das glân -dulas paratiróides inferior ao limite de resolução do método. Dados de literatura mostram que a sensibilidade do método cintilográfico para a detecção de glândulas hiperplásicas é inferior àquela para detecção de adenomas (10)(11)(12).…”

Section: Discussionunclassified

“…Outro ponto importante é a observação de que nosso índice de positividade, ao redor de 50% utilizando os critérios de corte acima definidos, seja aparentemente inferior à sensibilidade >70% relatada na maioria dos trabalhos publicados (10)(11)(12)(13). Isto, no entanto, pode ser justificado pelo fato destes estudos terem restringido sua análise ao grupo de pacientes submetidos à cirurgia -de outra forma não se poderia falar em sensibilidade e especificidade -levando claramente a um viés de seleção.…”

Section: Cálcio Pth E Cintilografia Das Paratiróidesunclassified

Relação dos níveis séricos de cálcio e paratormônio com a positividade da cintilografia das paratiróides

Duarte

Fujikawa

Brandão

et al. 2002

Arq Bras Endocrinol Metab

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Arq Bras Endocrinol Metabvol 46 nº 6 Dezembro 2002 654 RESUMOO hiperparatiroidismo primário (HPP) é caracterizado pelo aumento da secreção de PTH, com conseqüente aumento da concentração sérica de cálcio. O diagnóstico é realizado pela dosagem de cálcio e PTH. A cintilografia das paratiróides é solicitada, classicamente, em pacientes com recorrência de HPP após paratiroidectomia, na tentativa de detectar glândulas patológicas ectópicas ou remanescentes. Algumas vezes este exame tem sido solicitado antes do primeiro ato cirúrgico, na tentativa de localizar as glândulas comprometidas e abreviar a duração da cirurgia; na nossa casuística, no entanto, a maioria dos exames solicitados com esta indicação resulta negativa. Comparamos os níveis séricos de cálcio e PTH nos pacientes com cintilografia das paratiróides positiva, com aqueles dos pacientes com cintilografia negativa, a fim de tentar definir níveis com índice maior de positividade na cintilografia. Foram estudados retrospectivamente 74 pacientes consecutivos submetidos à cintilografia das paratiróides. Avaliou-se a utilização dos valores mais baixos de PTH (79pg/mL) e cálcio (10mg/dL) registrados no grupo com cintilografia positiva como referência para a indicação do exame. No grupo total de pacientes, 17 (23%) apresentaram cintilografia positiva. No subgrupo com valores de PTH ≥ 79pg/mL e de cálcio ≥ 10 mg/dL a porcentagem de exames positivos foi de 49%. Concluímos que cintilografias das paratiróides realizadas antes da cirurgia de paratiroidectomia em pacientes com níveis de cálcio sérico abaixo do limite superior da normalidade ou níveis de PTH pouco aumentados são, na maioria das vezes, negativas. Primary hyperparathyroidism (PHP) is characterized by increased secretion of PTH and consequent increase in plasma calcium concentration. Diagnosis is based on the measurement of serum calcium and PTH concentrations. Parathyroid scintigraphy is classically performed in patients with recurrent PHP after resection of the parathyroids, aiming the detection of remnants or ectopically located parathyroid adenomas. Sometimes, parathyroid scintigraphy is requested before the first surgery, in order to localize the pathological glands and abbreviate the duration of the surgical procedure; however, in our series of patients, most of the exams performed with this purpose were negative. We compared serum calcium and PTH levels in a group of patients with positive or negative scintigraphy in order to define the best calcium and PTH levels to perform scintigraphy. Seventy-four consecutive parathyroid scintigraphies were retrospectively analyzed. The use of the lower values of PTH (79pg/mL) and calcium (10mg/dL) in the group of patients with positive scintigraphy were assessed as a reference level for the indication of parathyroid artigo original

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“…Tc-99-sestamibi scintigraphy (MIBI) is most commonly used and frequently advocated as the initial investigation [11]. Its sensitivity is reported as high as 71% -93% [12][13][14][15][16][17]. While MIBI identifies a hyperfunctional parathyroid gland (PG), ultrasonography (US) and CT-scanning (CT) of the neck detect an enlarged PG.…”

Section: Introductionmentioning

confidence: 99%

Additional Imaging Following a Negative Sestamibi Scan in Primary Hyperparathyroidism

Twigt¹,

Vollebregt²,

Hooge³

et al. 2012

IJOHNS

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Background: The objective of this study was to assess the additional yield of US and CT following a "negative" initial MIBI-scintigraphy (MIBI) in patients with primary hyperparathyroidism. Methods: Prospective data were collected regarding 100 consecutive patients, preferentially undergoing a minimally invasive parathyroidectomy (MIP). MIBI was the initial imaging study for localizing a solitary adenoma, followed by US and CT (US/CT) in "MIBI-negative"-patients. Results: Surgery led to normocalcemia in 98 patients (98%) after one operation. Overall 97 patients had solitary parathyroid disease while three patients had multiglandular disease. The sensitivity of imaging increased from 74% for MIBI alone to 92% following subsequent US/CT in "MIBI-negative"-patients. The positive predictive value of a "positive" MIBI was 96% and 76% of a positive US/CT following negative MIBI. The proportion of patients who underwent successful MIP increased from 60 to 72%. Conclusions: MIBI and the combination of US and CT are complementary imaging studies. Additional localization studies after a negative sestamibi scan enhances the number of patients with primary hyperparathyroidism profiting from a minimally invasive approach.

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Preoperative parathyroid localization with sestamibi

Cited by 51 publications

References 7 publications

Localization of parathyroid tumours in the minimally invasive era: which technique should be chosen? Population-based analysis of 253 patients undergoing parathyroidectomy and factors affecting parathyroid gland detection.

Localization of parathyroid tumours in the minimally invasive era: which technique should be chosen? Population-based analysis of 253 patients undergoing parathyroidectomy and factors affecting parathyroid gland detection.

Relação dos níveis séricos de cálcio e paratormônio com a positividade da cintilografia das paratiróides

Additional Imaging Following a Negative Sestamibi Scan in Primary Hyperparathyroidism

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