Primary Hyperparathyroidism and Negative Tc99 Sestamibi Imaging: To Operate or Not?

Dy, Benzon M.; Richards, Melanie L.; Vazquez, Bianca J.; Thompson, Geoffrey B.; Farley, David R.; Grant, Clive S.

doi:10.1245/s10434-012-2325-3

Cited by 58 publications

(58 citation statements)

References 22 publications

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“…In our series, the incidence of MGD was 18%, which was within the range of 3-24% reported in the literature (20). The rate of MGD in cases of negative PS has been reported as w25% (21,22,23). Therefore, negative localization with sestamibi infers a highly selected patient population with small parathyroid adenomas and/or MGD.…”

Section: European Journal Of Endocrinologysupporting

confidence: 78%

“…Therefore, negative localization with sestamibi infers a highly selected patient population with small parathyroid adenomas and/or MGD. It has been shown that the cure rate was lower in this subgroup of patients (21,22). It is currently accepted that besides some cellular-molecular specificities, one possible explanation for decreased detection of MGD (often hyperplasic) is related to their smaller volume compared with adenomas.…”

Section: European Journal Of Endocrinologymentioning

confidence: 81%

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Preoperative imaging for focused parathyroidectomy: making a good strategy even better

Guérin

Lowery

Gabriel

et al. 2015

European Journal of Endocrinology

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Objective: Surgical treatment for primary hyperparathyroidism (pHPT) has undergone a major paradigm shift during the last decades from bilateral cervicotomy with four-gland neck exploration to image-guided focused approaches. The primary objective of the present study was to compare the performances of parathyroid scintigraphy (PS), parathyroid ultrasonography (US), and the combination of both procedures for guiding a focused approach on the basis of modified interpretation criteria. Methods: Data from 199 patients operated for apparent sporadic pHPT and evaluated with US and PS using dual-isotope 123 I/ 99m Tc-sestamibi planar pinhole and single-photon emission computed tomography (SPECT) acqusitions were evaluated. Results: A total of 127 patients underwent a focused approach and the remainder had bilateral cervicotomy. In 42 cases, a focused approach was not performed due to the absence of concordant results between US and PS for a single-gland abnormality. Four patients had persistent disease and three had recurrent disease. A localizing preoperative PS had a sensitivity of 93.3%, positive predictive value of 85.8%, negative predictive value of 73.0%, and accuracy of 83.4% for predicting uniglandular disease. Additional SPECT images accurately localize posterior adenomas that are often missed by US. Compared with PS, US had a lower sensitivity (P!0.01). Our imaging protocol also enabled diagnosis of multiglandular disease in 60.6%. Conclusions: PS using a highly sensitive dual-tracer subtraction method is the most accurate technique for directing a focused approach. PS could be sufficient for directing a focused approach in the presence of a negative US in two major circumstances: posterior locations due to acquired ectopia that could be missed by US, and previous history of thyroidectomy due to interpretation difficulties.

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Section: European Journal Of Endocrinologysupporting

confidence: 78%

Section: European Journal Of Endocrinologymentioning

confidence: 81%

Preoperative imaging for focused parathyroidectomy: making a good strategy even better

Guérin

Lowery

Gabriel

et al. 2015

European Journal of Endocrinology

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“…5 In the last 30 years, the wide use of the multichannel autoanalyzer; use of USG, MIBI, computed tomography (CT), and MRI for the diagnosis of PHPT; and new surgical methods and techniques for the surgical treatment of PHPT have resulted in easier diagnosis of the disease, correct localization of pathologic lesions, and different surgical approaches. 1,[5][6][7][8][9][10][11][12][13][14][15][16][17] The aim of this study was to present our 20-yearexperience with 190 patients diagnosed with PHPT, their clinical features, diagnostic methods, surgical treatment and pathology, and review of the literature.…”

mentioning

confidence: 99%

“…These new imaging and diagnostic methods include USG, MIBI scintigraphy, MRI, MIBI scintigraphy with the use of CT, and intraoperative adjuncts, such as a gamma probe with radioisotope sestamibi, intraoperative rapid PTH measurements, and the use of methylene blue or frozen section. [5][6][7][8][9][10][11][12][13][14][15][16][17] USG is a cheap, adequate, and noninvasive modality. Sensitivity of USG is associated with the user, the size and localization of the adenoma and concomitant thyroid disorder.…”

mentioning

confidence: 99%

A 20-Year Study on 190 Patients With Primary Hyperparathyroidism in a Developing Country: Turkey Experience

Usta

Alhan

Çinel

et al. 2015

International Surgery

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The aim of this study was to present our 20-year experience regarding primary hyperparathyroidism (PHPT). PHPT patients who underwent parathyroidectomy in our clinic were reviewed retrospectively. There were 190 PHPT patients, of whom 137 were asymptomatic (72%). The mean serum calcium at the time of diagnosis was 11.9 6 2.2 mg/dL. The mean parathyroid hormone (PTH) level was 467 6 78 pg/mL. Ultrasonography (USG) identified all abnormal glands accurately (82.6%) and Technetium-99m sestamibi scintigraphy (MIBI) was used in 89.4% of the patients and magnetic resonance imaging (MRI) in 61%. The common use of USG and MIBI detected 92% of the lesions. Bilateral neck exploration (BNE) was performed in 12.2% of the patients and focused unilateral neck exploration (FUNE) in the remaining 87.8%. Surgical intervention was unsuccessful in 1 patient (0.5%). The conversion ratio from FUNE to BNE was 5.2%. The mean operation time and mean hospital stay decreased significantly in patients with FUNE. Pathologic examination revealed single adenoma in 93% of the patients. New imaging techniques result in the conversion of surgical treatments of PHPT. FUNE in parathyroidectomy performed by an experienced surgeon may provide successful treatment rates.

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“…En nuestra experiencia, el porcentaje de FN del cintigrama paratiroideo en pacientes con HPP confirmado bioquímicamente, fue similar a lo descrito en otras publicaciones 12,13 . El factor más comúnmente reportado como causa de falsos negativos es el tamaño de la glándula paratiroidea.…”

Section: Discussionunclassified

Análisis de falsos negativos en la cintigrafía SPECT de paratiroides con sestamibi en pacientes con hiperparatiroidismo primario sometidos a cirugía entre 2008-2015 en hospital universitario

et al. 2017

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Primary Hyperparathyroidism and Negative Tc99 Sestamibi Imaging: To Operate or Not?

Abstract: A curative operation is performed at an acceptably lower rate with negative MIBI imaging. A decision for surgery with a negative MIBI finding should consider lower cure rates and symptom severity.

Cited by 58 publications

References 22 publications

Preoperative imaging for focused parathyroidectomy: making a good strategy even better

Preoperative imaging for focused parathyroidectomy: making a good strategy even better

A 20-Year Study on 190 Patients With Primary Hyperparathyroidism in a Developing Country: Turkey Experience

Análisis de falsos negativos en la cintigrafía SPECT de paratiroides con sestamibi en pacientes con hiperparatiroidismo primario sometidos a cirugía entre 2008-2015 en hospital universitario

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