Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism.

Abstract

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 and three (3.3%) patients had diffuse PT hyperplasia. The overall sensitivity of combined SS+US was 94.5% (86.8% and 80.4% for SS and US respectively). There was a significant (P<0.05, Student's t-test) difference in size between the PT glands correctly identified and undetected by SS, whereas the site of the removed PT tumors significantly (P<0.05, Fisher exact test) influenced only the US sensitivity.

CONCLUSIONS:

When the preoperative localization of the PT glands is chosen, the combination of SS and US represents a reliable noninvasive localization technique and should be considered for use in each patient with pHPT undergoing surgery.

• Authors: F Lumachi, P Zucchetta, M C Marzola, P Boccagni, F Angelini, F Bui, D F D'Amico, G Favia
• Journal: European journal of endocrinology (Eur J Endocrinol) Vol. 143 Issue 6 Pg. 755-60 (Dec 2000) ISSN: 0804-4643 [Print] England
• PMID: 11124858 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Radiopharmaceuticals
• Technetium Tc 99m Sestamibi

Topics

• Adenoma (diagnostic imaging, pathology, surgery)
• Adolescent
• Adult
• Aged
• Female
• Humans
• Hyperparathyroidism (diagnostic imaging, pathology, surgery)
• Male
• Middle Aged
• Parathyroid Glands (diagnostic imaging, pathology, surgery)
• Parathyroid Neoplasms (diagnostic imaging, pathology, surgery)
• Radionuclide Imaging
• Radiopharmaceuticals
• Recurrence
• Reproducibility of Results
• Sensitivity and Specificity
• Technetium Tc 99m Sestamibi
• Ultrasonography