Technetium-99m sestamibi parathyroid localization is accurate enough for scan-directed unilateral neck exploration

Abstract

A retrospective study was conducted into technetium-99m sestamibi imaging of primary hyperparathyroidism to determine the accuracy of identification and localization of parathyroid pathology. Of 56 patients studied, 48 had full preoperative scan data, operative data and pathological results analysed. Overall scan accuracy was 96 per cent. For single gland pathology (adenoma) imaging had a sensitivity of 97 per cent, a specificity of 100 per cent and a positive predictive value of 100 per cent. For single gland disease the side was correctly identified in 100 per cent of cases and the site in 94 per cent, but the respective values were only 82 and 79 per cent for multiple gland pathology. Technetium-99m sestamibi imaging is highly sensitive and accurate for primary hyperparathyroidism, with sufficient positive predictive value and accuracy in single gland disease to allow scan-directed unilateral neck exploration.

Hyperfunctioning parathyroid tumours in patients with thyroid nodules. Sensitivity and positive predictive value of high-resolution ultrasonography and 99mTc-sestamibi scintigraphy.

“…In the era of minimally invasive surgery, the number of patients with primary HPT who should undergo bilateral neck exploration is less than in the past (Borley et al 1996, Norman & Chheda 1997, Inabnet et al 1999, Miccoli et al 1999. However, in the presence of a solitary thyroid nodule or multinodular thyroid disease there is the need to perform 422 www.endocrinology.org both parathyroidectomy and thyroidectomy at the same time, and a more extensive surgical approach is usually requested.…”

Technetium-99m-sestamibi/pertechnetate subtraction scintigraphy vs ultrasonography for preoperative localization in primary hyperparathyroidism

“…In the past decade, different scintigraphic techniques have been used to localize hyperfunctional parathyroid glands [2,3,5,6,7,8,9,10,11,12,13]. Radionuclide scans have been proven to be an effective method for localizing parathyroid glands [10,11,12,13].…”

Visualization of Parathyroid Hyperplasia Using 18F-Fluorocholine PET/MR in a Patient With Secondary Hyperparathyroidism

“…Ultrasonography (not shown) was negative as well. 3 ) causes hypocalcemia, which is corrected by an appropriate increase in PTH synthesis. Tertiary hyperparathyroidism develops if this endocrine relationship is uncoupled and PTH secretions increase despite normal or even elevated serum calcium.…”

“…[3][4][5][6] Negative imaging findings in patients with hyperparathyroidism are a problem. 7 Recently, dynamic contrast-enhanced CT imaging and choline PET/CT imaging have been advocated to identify parathyroid adenomas if conventional imaging was negative.…”