Parathyroid scintigraphy and minimal invasive surgery in parathyroid adenomas (original) (raw)
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Asian Journal of Medicine and Health
Background: Primary hyperparathyroidism (PHPT) is an endocrine disorder with increased secretion of parathyroid hormone and elevated serum calcium level. Parathyroid adenoma is the most common cause. The introduction of preoperative localization of parathyroid adenoma using 99mTc-sestaMIBI has made parathyroid surgery minimally invasive. It becomes important to determine its usefulness in actual localization of parathyroid adenoma by correlating such with surgical and histological outcomes. Methods: This is a retrospective evaluation which involved electronic data retrieval for patients with biochemical diagnosis of hyperparathyroidism who presented for parathyroid nuclear scan and subsequently had surgical resection and histopathological diagnosis at the UAH. A total of 11
Irish Journal of Medical Science, 2011
Background There are conflicting data in the literature about the sensitivity of sestamibi scintigraphy in parathyroid tumour localisation in primary hyperparathyroidism (PHPT). Aim We aimed to evaluate the overall sensitivity of this modality in parathyroid tumour localisation and to determine clinical and biochemical factors which influence sensitivity of this method. Methods We performed a retrospective review of 57 patients with a biochemical diagnosis of PHPT who had sestamibi scintigraphy performed. Results The sensitivity of sestamibi scanning was 56% in whole group and 63% in those without nodular thyroid disease. Among the patients with confirmed single gland disease (biochemical cure after surgical removal of a single adenoma), sensitivity was 71%. A positive scan was associated with younger age, greater adenoma weight and higher pre-operative serum calcium. Concordance between the sestamibi and neck ultrasonography was 92% accurate in pre-operative tumour localisation. Conclusion Sestamibi scintigraphy was more likely to be positive in younger patients without nodular thyroid disease who have larger parathyroid adenomas with more severe hyperparathyroidism.
European Journal of Endocrinology, 2000
OBJECTIVE: To evaluate the usefulness of the combination of Tc-sestamibi/Tc-pertechnetate subtraction scintigraphy (SS) and high-resolution neck ultrasonography (US) in patients with primary hyperparathyroidism (pHPT) undergoing parathyroidectomy. DESIGN AND METHODS: Ninety-one patients with proved pHPT were studied, excluding patients with persistent or recurrent disease. There were 65 (71.4%) women and 26 (28.6%) men, with a median age of 59 years (range 18-78 years). All patients underwent both SS and US prior to surgery, and the results were compared with operative and histological findings. The intraoperative quick-parathyroid hormone assay was available for 52 (57.1%) patients. When multiglandular disease was found, both SS and US were considered truly positive only when at least two enlarged parathyroid (PT) glands had been localized. RESULTS: Eighty-three (91.2%) solitary PT adenomas and three (3.3%) carcinomas were found. Moreover, two (2.2%) patients had a double adenoma a...
Preoperative 99Tcm-sestamibi scintigraphy with SPECT localizes most pathologic parathyroid glands
Langenbeck's Archives of Surgery, 2009
Background and aims Surgery is the only curative treatment for primary hyperparathyroidism. Focused surgical techniques are being practiced with increasing frequency. Preoperative imaging, such as scintigraphy, is a prerequisite for focused surgery. There is controversy about which preoperative imaging method should be used. The sensitivity reported for parathyroid scintigraphy varies considerably. This study was designed to determine the accuracy of the preoperative imaging routinely used at our institution. Material and methods This retrospective study included consecutive patients who underwent a routine dual-phase sestamibi-SPECT (single photon emission computed tomography) scintigraphy and subsequent operation with follow-up. Scintigraphy results were evaluated by comparing the results to surgical findings and histopathology. Results Two hundred and sixty-four individuals entered the study. Sensitivity for scintigraphy was 84%, specificity 91%, positive predictive value 91%, and negative predictive value 84%. Conclusions Sestamibi-SPECT scintigraphy is a sensitive preoperative modality with high positive predictive value. Scintigraphy is a good indicator for when to perform a focused surgical approach and could often correctly guide the actual operation.
Journal of Clinical Ultrasound, 2007
Purpose. To evaluate the sensitivity, specificity, and usefulness of dual-phase 99mTc-Sestamibi scintigraphy (SS) and sonography (US) of the neck, alone and in combination, as noninvasive adenoma localizing procedures in patients with primary hyperparathyroidism prior to parathyroidectomy.Methods. We retrospectively analyzed the charts of 79 patients with parathyroid (PT) adenomas and confirmed diagnosis of hyperparathyroidism who were evaluated with SS and US prior to successful parathyroidectomy.Results. Ninety-three adenomas were removed during bilateral neck exploration. SS alone showed a sensitivity of 76% and a specificity of 79% compared with 89% and 75%, respectively, for US performed after SS on the same day. Combination of the 2 procedures yielded a sensitivity of 89% and a specificity of 90%, with 22% discordant results. The differences in sensitivity and specificity between the 2 techniques alone or in combination were not statistically significant.Conclusions. No benefit was gained from using both SS and US for the preoperative localization of PT adenomas in patients with primary hyperparathyroidism. Each technique can be negatively affected by thyroid enlargment and nodularity. US, when performed by a skilled operator, is a reliable tool for PT adenoma localization. If the US findings are inconclusive, SS should be used. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2007
Endocrine Practice, 2004
Objective: To assess the diagnostic properties of 99m Tc-sestamibi scanning (dual-phase technique) in patients with primary hyperparathyroidism and to establish the overall efficacy of this imaging technique for localization of an adenoma. Methods: The medical records of all 131 patients who underwent parathyroid scanning in a tertiary care center between January 1997 and December 2002 were reviewed. The surgical findings were used as the "gold standard" for the diagnosis of parathyroid pathologic conditions. Results: Primary hyperparathyroidism was diagnosed in 87 of the 131 patients (66.4%); of these, 76 underwent surgical treatment. In 44 patients, sestamibi scanning was also done for conditions other than primary hyperparathyroidism. 99m Tc-sestamibi scanning had a sensitivity of 79.1%, a specificity of 86.7%, a positive predictive value of 88.3%, a false-positive rate of 11.6%, and a false-negative rate of 23.3% for the diagnosis of parathyroid adenoma. Despite the apparent high sensitivity of this scanning technique, only 58.2% of the adenomas were found intraoperatively at the location predicted by the scan. Lesions in the upper neck area were missed more frequently by sestamibi scanning than were those in the lower neck area (13 of 32 versus 1 of 35, respectively) (P<0.05). Conclusion: Preoperative localization of parathyroid adenomas with use of 99m Tc-sestamibi scanning showed a limited capacity to reveal their precise location. Thus, such scans must be complemented with other studies, such as intraoperative ultrasonography and rapid parathyroid hormone assay, to ensure a successful excision if a limited surgical procedure is planned.
International Surgery Journal, 2016
Background:Ultrasonography is cheap, easily available and convenient modality of diagnosis.Methods: We prospectively studied 61 patients with PHPT. Patients preoperatively underwent USG neck and MIBI scan, results were interpreted independently and compaired with intra operative findings.Results:61 patients who underwent parathyroidectomy for PHPT were studied. Ultrasonography neck showed correct side in 46/51 (90%) and correct site in 32/51 (63%) patients with single parathyroid adenomas. MIBI scan showed correct side and site of parathyroid adenoma in 46/50 (92%) and 43/50 (86%) patients respectively. Patients with double adenomas USG neck showed positive results in all 5 patient with 100% sensitivity where as MIBI scan showed positive results in four out of five patients (80%). 1 patient with four gland hyperplasia USG picked three out of four enlarged glands while as MIBI scan not picked any of the enlarged glands. Operative findings revealed that right lower parathyroid gland w...
Clinical Endocrinology, 1995
OBJECTIVE The use of preoperative imaging in patients with hyperparathyroidism remains controversial. Many of the available techniques are insufficiently sensitive and specific to justify their routine use. We have evaluated the Sensitivity and specificity of 99mTc-sestamibi scintigraphy in the management of patients with different forms of hyperparathyroidism. DESIGN Preoperative imaging evaluation was carried out by sclntigraphic detection of pathological parathyroid glands using gamTc-sestamibi as a radiotracer; confirmation of scan findings was obtained surgically. PATIENTS A group of 25 patients with primary (n = 21) or secondary (n = 4) hyperparathyroidism were studied. All were considered for surgical treatment. MEASUREMENTS In all cases parathyroid imaging was carried out by gemTc-sestamibi scintigraphy together with at least one other imaging technique which included CTscan, ultrasonography, MRI or 201TI/semT~ subtraction scintigraphy. Blood tests included measurements of total calcium and PTH. RESULTS ggmTc-sestamibi scintigraphy correctly localized 20 out of 21 adenomas, giving a sensitivity of 95-2%, markedly higher than that obtained with the other imaging techniques (ultrasonography 75%, 201T1/9smT~ subtraction scintigraphy 57.1 %, CT-scan 41.7% and MRI 33%). Of a total of 17 glands identified surgically as hyperplastic and confirmed by pathological examination, ggmTc-sestamlbi scintigraphy showed a Correspondence: Dr Manel Puig-Domingo, Servei d'Endocrinologia, Hospital de Sant Pau, Av s. Antoni M Claret No 167, Barcelona 08025, Spain. Fax: 010 343 2919270.
The American Journal of Surgery, 2013
BACKGROUND: In hyperparathyroidism, dual-phase technetium-99m sestamibi scintigraphy is important for parathyroid adenoma localization. We hypothesized that reviewing early-phase scans can increase localization in patients with primary hyperparathyroidism (PHPT). METHODS: We reviewed our prospectively maintained database for patients with sestamibi scans before parathyroidectomy for PHPT from 2001 to 2011. Early-phase scans were read and compared with the location of the gland(s) removed at operation. RESULTS: Of 902 patients identified, radiologists read 693 scans as positive. Of 209 negative scans, 141 (67%) were positive in the early phase; 135 (96%) correctly identified the side of the adenoma. Using radiologist reads, 35% of patients with negative scans and 41% of patients with falsely localized glands required bilateral exploration compared with 5% of patients with correctly localized glands. CONCLUSIONS: A review of early scans in patients with negative imaging increases accurate adenoma localization and allows for minimally invasive operations in more patients.