Technetium-99m-sestamibi subtraction scintigraphy vs. ultrasonography combined with a rapid parathyroid hormone assay in parathyroid aspirates in preoperative localization of parathyroid adenomas and in directing surgical approach

• Published in: Clinical endocrinology (Oxford) 2006-07, Vol.65 (1), p.106-113
• Main Authors: Barczynski, Marcin, Golkowski, Filip, Konturek, Aleksander, Buziak-Bereza, Monika, Cichon, Stanislaw, Hubalewska-Dydejczyk, Alicja, Huszno, Bohdan, Szybinski, Zbigniew
• Format: Article
• Language: English
• Subjects: Adenoma - diagnostic imaging; Adolescent; Adult; Aged; Biological and medical sciences; Biopsy, Fine-Needle; Chi-Square Distribution; Endocrinopathies; Female; Fundamental and applied biological sciences. Psychology; Goiter, Nodular - blood; Goiter, Nodular - surgery; Humans; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Parathyroid Glands - diagnostic imaging; Parathyroid Hormone - blood; Parathyroid Neoplasms - blood; Parathyroid Neoplasms - diagnosis; Parathyroid Neoplasms - surgery; Parathyroidectomy; Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases); Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Signal Processing, Computer-Assisted; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Nodule - blood; Thyroid Nodule - surgery; Ultrasonography, Doppler; Vertebrates: endocrinology
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1111/j.1365-2265.2006.02556.x

Summary Objective  To determine the sensitivity and positive predictive value (PPV) of subtraction scintigraphy (SS) vs. ultrasonography (US) of the neck combined with rapid intact parathyroid hormone (iPTH) assay in US‐guided fine‐needle parathyroid aspirates in preoperative localization of parathyroid adenomas and in directing surgical approach. Design  The results of SS for localization of parathyroid adenoma were determined in 121 patients with primary hyperparathyroidism (pHPT) and compared with findings at surgery and with the results of US alone (in patients without nodular goitre) and US in combination with the iPTH assay in US‐guided fine‐needle aspirates (FNAs) of suspicious parathyroid lesions (in patients with concomitant nodular goitre). Patients  All 121 patients had biochemically documented pHPT; all were referred for first‐time surgery. Measurements  SS was performed with 99mTc‐sestamibi and 99mTc‐pertechnetate. High‐resolution US of the neck was performed by a single endocrine surgeon and combined with US‐guided FNAs of suspicious parathyroid lesions in all patients with nodular goitre (n = 43). Results  The sensitivity and PPV of SS were significantly higher in patients without vs. with goitre (89·3% and 95·7%vs. 74·3% and 76·5%, respectively; P