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Chasing “Shadows”: Discovering the Subtleties of Sestamibi Scans to Facilitate Minimally Invasive Parathyroidectomy

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Abstract

Background

With the advent of sestamibi scans, high-resolution ultrasonography (US), and intraoperative intact parathyroid hormone (PTH) measurements, minimally invasive parathyroidectomy (MIP) is considered the standard of care for patients with primary hyperparathyroidism (PHPT). Preoperative imaging, however, can be negative more than 20% of the time.

Methods

We chose to examine one surgeon’s experience with patients who presented with PHPT and negative or indeterminate preoperative imaging from July 1993 to September 2009. A retrospective review of a parathyroid surgery database and patient records was conducted to collect the following information: patient age and sex; calcium and PTH levels; sestamibi and US results; and operative reports. Each sestamibi scan had been re-reviewed preoperatively by the surgeon with a nuclear medicine physician. The study cohort included patients with negative or indeterminate sestamibi results and a negative or no US report in which the surgeon was able to identify a “shadow” or subtlety on sestamibi and plan an MIP.

Results

A total of 126 patients had a negative or indeterminate sestamibi scan and a negative or no US report. “Shadows” or subtleties were found in 18 of 44 (41%) of the cases with a negative sestamibi and in 62 of 82 (76%) of cases with an indeterminate sestamibi scan. For these 80 cases a MIP was planned. In all, 7 of 80 (9%) were converted to a bilateral exploration. The remaining 46 patients underwent a planned bilateral exploration. Cure rates were comparable: 99% in the study group compared to 97% in the group who underwent a planned or converted bilateral exploration.

Conclusions

With careful preoperative re-review of a negative or indeterminate sestamibi scan and the identification of subtleties in patients with a negative preoperative US scan, a successful MIP can be performed 91% of the time with a 98% cure rate.

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Acknowledgments

We thank Ms. Catherine Y. Jones for her administrative assistance. Dr. Kouniavsky received grants from the Israel Cancer Association and American Physicians Fellowship for Medicine in Israel.

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Authors and Affiliations

  1. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA

    Vladimir K. Neychev, Guennadi Kouniavsky, Zita Shiue, Helina Somervell, Christopher B. Umbricht & Martha A. Zeiger

  2. Department of Endocrine Surgery Section and Nuclear Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA

    Don N. Udall

  3. 600 N. Wolfe Street, Blalock 606, Baltimore, MD, 21217, USA

    Martha A. Zeiger

Authors
  1. Vladimir K. Neychev
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  2. Guennadi Kouniavsky
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  3. Zita Shiue
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  4. Don N. Udall
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  5. Helina Somervell
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  6. Christopher B. Umbricht
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  7. Martha A. Zeiger
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Corresponding author

Correspondence to Martha A. Zeiger.

Additional information

This paper article is from the Scientific Papers Session in Endocrine Surgery at the 2009 ACS Clinical Congress.

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Neychev, V.K., Kouniavsky, G., Shiue, Z. et al. Chasing “Shadows”: Discovering the Subtleties of Sestamibi Scans to Facilitate Minimally Invasive Parathyroidectomy. World J Surg 35, 140–146 (2011). https://doi.org/10.1007/s00268-010-0800-1

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