Skip to main content
Log in

The Utility of Neck Ultrasound and Sestamibi Scans in Patients with Secondary and Tertiary Hyperparathyroidism

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Introduction

Secondary hyperparathyroidism (SHPT) and tertiary hyperparathyroidism (THPT) are disease entities in patients with chronic kidney disease that are caused by parathyroid hyperplasia. The role of preoperative localization studies in patients undergoing parathyroidectomy for these conditions remains poorly defined.

Aim

To evaluate the utility of surgeon-performed neck ultrasound (US) as well as sestamibi scans in the localization of parathyroid glands in patients with SHPT/THPT.

Materials and methods

A retrospective analysis of patients with SHPT/THPT who underwent parathyroidectomy at a single institution. Results of preoperative localization studies were compared to intraoperative findings.

Results

One hundred and three patients underwent parathyroidectomy for SHPT/THPT. All patients underwent surgeon-performed neck US, while 92 (89 %) underwent sestamibi scans. US failed to localize any of the parathyroids in 4 patients (3.8 %), while sestamibi was negative in 11 (12 %). Forty-seven ectopic glands were identified in 38 patients in whom sestamibi was performed. In five patients (13 %), ectopic glands were identified by both modalities, by US only in 6 (16 %), by sestamibi only in 8 (21 %), and by neither study in 19 patients (50 %). US showed new thyroid nodules in 19 patients (18.4 %), leading to lobectomy or thyroidectomy at the time of parathyroidectomy in 16 patients (15.5 %). Pathology showed malignancy in 7 patients (6.8 %).

Conclusion

US and MIBI offer little benefit in localizing ectopic glands and rarely change the conduct of a standard four-gland exploration. Although there was a benefit of US in the assessment of thyroid nodules, in only 8.7 % of patients was sestamibi of benefit in identifying ectopic glands.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gagne ER, Urena P, Leite-Silva S et al (1992) Short- and long-term efficacy of total parathyroidectomy with immediate autografting compared with subtotal parathyroidectomy in hemodialysis patients. J Am Soc Nephrol 3(4):1008–1017

    CAS  PubMed  Google Scholar 

  2. Kaye M, D’Amour P, Henderson J (1989) Elective total parathyroidectomy without autotransplant in end-stage renal disease. Kidney Int 35(6):1390–1399

    Article  CAS  PubMed  Google Scholar 

  3. Llach F (1990) Parathyroidectomy in chronic renal failure: indications, surgical approach and the use of calcitriol. Kidney Int Suppl 29:S62–S68

    CAS  PubMed  Google Scholar 

  4. Akerstrom G, Malmaeus J, Bergstrom R (1984) Surgical anatomy of human parathyroid glands. Surgery 95(1):14–21

    CAS  PubMed  Google Scholar 

  5. Roy M, Mazeh H, Chen H, Sippel RS (2013) Incidence and localization of ectopic parathyroid adenomas in previously unexplored patients. World J Surg 37(1):102–106. doi:10.1007/s00268-012-1773-z

    Article  PubMed  Google Scholar 

  6. Pavlovic D, Brzac HT (2003) Prevention and treatment of secondary hyperparathyroidism: still a challenge for the nephrologist? Nephrol Dial Transplant 18(Suppl 5):v45–v46

    Article  PubMed  Google Scholar 

  7. Caldarella C, Treglia G, Pontecorvi A, Giordano A (2012) Diagnostic performance of planar scintigraphy using (9)(9)mTc-MIBI in patients with secondary hyperparathyroidism: a meta-analysis. Ann Nucl Med 26(10):794–803

    Article  PubMed  Google Scholar 

  8. Neumann DR, Esselstyn CB Jr, Madera A, Wong CO, Lieber M (1998) Parathyroid detection in secondary hyperparathyroidism with 123I/99mTc-sestamibi subtraction single photon emission computed tomography. J Clin Endocrinol Metab 83(11):3867–3871

    Article  CAS  PubMed  Google Scholar 

  9. Jeanguillaume C, Urena P, Hindie E et al (1998) Secondary hyperparathyroidism: detection with I-123-tc-99m-sestamibi subtraction scintigraphy versus US. Radiology 207(1):207–213

    Article  CAS  PubMed  Google Scholar 

  10. Piga M, Bolasco P, Satta L et al (1996) Double phase parathyroid technetium-99m-MIBI scintigraphy to identify functional autonomy in secondary hyperparathyroidism. J Nucl Med 37(4):565–569

    CAS  PubMed  Google Scholar 

  11. Saengsuda Y (2012) The accuracy of 99m tc-MIBI scintigraphy for preoperative parathyroid localization in primary and secondary–tertiary hyperparathyroidism. J Med Assoc Thail 95(Suppl 3):S81–S91

    Google Scholar 

  12. Hindie E, Urena P, Jeanguillaume C et al (1999) Preoperative imaging of parathyroid glands with technetium-99m-labelled sestamibi and iodine-123 subtraction scanning in secondary hyperparathyroidism. Lancet 353(9171):2200–2204

    Article  CAS  PubMed  Google Scholar 

  13. Perie S, Fessi H, Tassart M et al (2005) Usefulness of combination of high-resolution ultrasonography and dual-phase dual-isotope iodine 123/technetium tc 99m sestamibi scintigraphy for the preoperative localization of hyperplastic parathyroid glands in renal hyperparathyroidism. Am J Kidney Dis 45(2):344–352

    Article  PubMed  Google Scholar 

  14. Adalet I, Hawkins T, Clark F, Wilkinson R (1994) Thallium–technetium-subtraction scintigraphy in secondary hyperparathyroidism. Eur J Nucl Med 21(6):509–513

    Article  CAS  PubMed  Google Scholar 

  15. Lai EC, Ching AS, Leong HT (2007) Secondary and tertiary hyperparathyroidism: role of preoperative localization. ANZ J Surg 77(10):880–882

    Article  PubMed  Google Scholar 

  16. Andrade JS, Mangussi-Gomes JP, Rocha LA et al (2014) Localization of ectopic and supernumerary parathyroid glands in patients with secondary and tertiary hyperparathyroidism: surgical description and correlation with preoperative ultrasonography and Tc99m-sestamibi scintigraphy. Braz J Otorhinolaryngol 80(1):29–34

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eren Berber.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alkhalili, E., Tasci, Y., Aksoy, E. et al. The Utility of Neck Ultrasound and Sestamibi Scans in Patients with Secondary and Tertiary Hyperparathyroidism. World J Surg 39, 701–705 (2015). https://doi.org/10.1007/s00268-014-2878-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-014-2878-3

Keywords

Navigation