99MTc-Sestamibi as sole technique in selection of primary hyperparathyroidism patients for unilateral neck exploration

• Published in: Surgery 2008-09, Vol.144 (3), p.454-459
• Main Authors: Moure, Dolores, Larrañaga, Eduardo, Domínguez-Gadea, Luis, Luque-Ramírez, Manuel, Nattero, Lia, Gómez-Pan, Antonio, Marazuela, Monica
• Format: Article
• Language: English
• Subjects: Adenoma - diagnostic imaging; Adenoma - surgery; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Endocrinopathies; Female; General aspects; Humans; Hyperparathyroidism, Primary - diagnostic imaging; Male; Medical sciences; Middle Aged; Neck - surgery; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Parathyroid Glands - diagnostic imaging; Parathyroid Glands - surgery; Parathyroid Neoplasms - diagnostic imaging; Parathyroid Neoplasms - surgery; Parathyroidectomy; Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases); Preoperative Care; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sestamibi
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2008.05.014

Unilateral neck exploration (UNE) is becoming the procedure of choice for treatment of primary hyperparathyroidism (PHPT). The aim of this study was to evaluate the role of 99mTc-sestamibi (MIBI) parathyroid scintigraphy as the sole technique in selecting patients for UNE. We selected 136 consecutive PHPT patients who had only 1 solitary uptake at a MIBI were for UNE. The technique was a single dual-phase using MIBI and a subtraction technique with 99mTc-pertechnetate. Imaging data were correlated with surgical results. In 3 cases, the sestamibi scan was falsely positive, 1 had a contralateral location relative to the uptake, and 2 had multiglandular hyperplasia. Overall, the positive predictive value (PPV) of MIBI for detecting a solitary parathyroid adenoma in patients with 1 solitary uptake was 97.8. Sixteen patients (12%) had evidence of multinodular goiter. Overall, the PPV of MIBI was 98.4% (2 false positive among 120 cases) in patients with no multinodular thyroid disease (MNG) and 93.7% (1 false negative among 16 cases) in patients with MNG. The mean duration of the surgical procedure was 34.17 minutes. Mean hospitalization was 0.6 days. Conversion to bilateral neck exploration was performed in 5 patients. After a period of follow-up of 40 months (range, 6–72 months), the cure rate was 98%. Patients with PHPT and unequivocally positive preoperative 99mTc-sestamibi can safely be managed with UNE without additional localizing techniques.