Irish Journal of Medical Science

, Volume 176, Issue 4, pp 283–287 | Cite as

Sestamibi scan-directed, minimally invasive video-assisted parathyroidectomy: an effective treatment for solitary parathyroid adenoma

  • A. D. Murphy
  • E. J. Andrews
  • A. Ishtiaq
  • A. Jawad
  • P. A. McCarthy
  • D. O’Keeffe
  • F. Dunne
  • D. S. Quill
Original Article



Solitary adenomas have been shown to be responsible for almost 90% of cases of primary hyperparathyroidism.


The purpose of this study was to determine the utility of sestamibi scanning pre-operatively to guide minimally invasive video-assisted (MIVA) parathyroidectomy.


We reviewed 40 patients who underwent parathyroidectomy between 2003 and 2004. All patients underwent a pre-operative sestamibi scan.


Thirty-three (82%) patients had a localized solitary adenoma on sestamibi scan. Of these patients 29 underwent attempted MIVA parathyroidectomy. MIVA parathyroidectomy was successful in 22 patients. When pre-operative sestamibi scanning was correlated with pathological diagnosis it was shown to have a sensitivity of 82% and positive predictive value of 94%.


Pre-operative sestamibi scan localization of a parathyroid adenoma offers a 94% positive predictive value for adenoma location. This facilitates MIVA parathyroidectomy to be used effectively to treat primary hyperparathyroidism in the majority of patients.


Hypercalcaemia Hyperparathyroidism Minimally invasive Parathyroid Sestamibi 


  1. 1.
    Ruda JM, Hollenbeak CS, Stack BC Jr (2005) A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg 132(3):359–72PubMedCrossRefGoogle Scholar
  2. 2.
    Parikshak M, Castillo ED, Conrad MF et al (2003) Impact of hypercalcemia and parathyroid hormone level on the sensitivity of preoperative sestamibi scanning for primary hyperparathyroidism. Am Surg 69(5):393–398PubMedGoogle Scholar
  3. 3.
    Clark OH (1995) Surgical treatment of primary hyperparathyroidism. Adv Endocrinol Metab 6:1–16PubMedGoogle Scholar
  4. 4.
    Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875PubMedCrossRefGoogle Scholar
  5. 5.
    Miccoli P, Bendinelli C, Vignali E et al (1998) Endoscopic parathyroidectomy: report of an initial experience. Surgery 124(6):1077–9PubMedCrossRefGoogle Scholar
  6. 6.
    Dijkstra B, Healy C, Kelly LM et al (2002) Parathyroid localisation current practice. J R Coll Surg Edinb 47:599–607PubMedGoogle Scholar
  7. 7.
    Ammori BJ, Madan M, Gopichandran TD et al (2002) Ultrasound guided unilateral neck exploration for sporadic primary hyperparathyroidism: is it worthwhile? Ann R Coll Surg Engl 80:433–437Google Scholar
  8. 8.
    Eisenberg H, Pallotta J, Sacks B et al (1998) Parathyroid localisation, three dimensional modelling and percutaneous ablation techniques. Endocrinol Metab Clin North Am 18:659–700Google Scholar
  9. 9.
    Denham DW, Norman J (1998) Cost-effectiveness of preoperative sestamibi scan for primary hyperparathyroidism is dependant solely upon the surgeons choice of operative procedure. J Am Coll Surg 186:293–304PubMedCrossRefGoogle Scholar
  10. 10.
    Koong HN, Choong LH, Soo KC (1998) The role of preoperative localisation techniques in surgery for hyperparathyroidism. Ann Acad Med Singapore 27:192–195PubMedGoogle Scholar
  11. 11.
    Wei FP, Burke GJ (1995) Analysis of savings in operative time for primary hyperparathyroidism using localization with technetium 99 m sestamibi scan. Am J Surg 170(5):488–491PubMedCrossRefGoogle Scholar
  12. 12.
    Sofferman RA, Nathan MH, Fairbank JT et al (1996) Preoperative technetium Tc 99 m sestamibi imaging paving the way to minimal-access parathyroid surgery. Arch Otolaryngol Head Neck Surg 122(4):369–374PubMedGoogle Scholar
  13. 13.
    Saaristo RA, Salmi JJ, Koobi T et al (2002) Intraoperative localization of parathyroid glands with gamma counter probe in primary hyperparathyroidism a prospective study. J Am Coll Surg 195(1):19–22PubMedCrossRefGoogle Scholar
  14. 14.
    Vassy WM, Nelson HS, Mancini ML et al (2003) Minimally invasive parathyroidectomy: how effective is preoperative sestamibi scanning? Am Surg 69(12):1090–4PubMedGoogle Scholar
  15. 15.
    Parikshak M, Castillo ED, Conrad MF et al (2003) Impact of hypercalcemia and parathyroid hormone level on the sensitivity of preoperative sestamibi scanning for primary hyperparathyroidism. Am Surg 69(5):393–8PubMedGoogle Scholar
  16. 16.
    Makras P, Kaltsas GA, Athanasoulis T et al (2005) Treatment with oral biphosphonates can increase the sensitivity of sestamibi radionuclide imaging in patients with primary hyperparathyroidism. Int J Clin Pharmacol Res 25(1):19–28PubMedGoogle Scholar
  17. 17.
    Solorzano CC, Carneiro-Pla DM, Irvin GL 3rd (2006) Surgeon-performed ultrasonography as the initial and only localizing study in sporadic primary hyperparathyroidism. J Am Coll Surg 202(1):18–24PubMedCrossRefGoogle Scholar
  18. 18.
    Gilat H, Cohen M, Feinmesser R (2005) Minimally invasive procedure for resection of a parathyroid adenoma: the role of preoperative high-resolution ultrasonography. J Clin Ultrasound 33(6):283–7PubMedCrossRefGoogle Scholar
  19. 19.
    Van Husen R, Kim LT (2004) Accuracy of surgeon-performed ultrasound in parathyroid localization. World J Surg 28(11):1122–6PubMedCrossRefGoogle Scholar
  20. 20.
    Scheiner JD, Dupuy DE, Monchik JM et al (2001) Pre-operative localization of parathyroid adenomas: a comparison of power and colour Doppler ultrasonography with nuclear medicine scintigraphy. Clin Radiol 56:984–988PubMedCrossRefGoogle Scholar
  21. 21.
    Purcell GP, Dirbas FM, Jeffrey RB et al (1999) Parathyroid localization with high-resolution ultrasound and technetium Tc 99 m sestamibi. Arch Surg 134:824–828PubMedCrossRefGoogle Scholar
  22. 22.
    Henry JF, Iacobone M, Raffaelli M, Mirallie E (2000) Videoscopic parathyroidectomy by complete lateral approach. In: Mouiel J, Montori A (eds) Proceedings of the 8th international congress of EAES. Monduzzi Editore, Bologna, pp 383–386Google Scholar
  23. 23.
    Lorenz K, Nguyen-Thanh P, Dralle H (2000) Unilateral open and minimally invasive procedures for primary hyperparathyroidism: a review of selective approaches. Langenbecks Arch Surg 385:106–117PubMedCrossRefGoogle Scholar
  24. 24.
    Miccoli P, Berti P, Conte M, Raffaelli M, Materazzi G (2000) Minimally invasive video-assisted parathyroidectomy: lesson learned from 137 cases. J Am Coll Surg 191:613–618PubMedCrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2007

Authors and Affiliations

  • A. D. Murphy
    • 1
    • 4
  • E. J. Andrews
    • 1
  • A. Ishtiaq
    • 1
  • A. Jawad
    • 1
  • P. A. McCarthy
    • 2
  • D. O’Keeffe
    • 2
  • F. Dunne
    • 3
  • D. S. Quill
    • 1
  1. 1.Department of SurgeryUniversity College HospitalGalwayIreland
  2. 2.Department of RadiologyUniversity College HospitalGalwayIreland
  3. 3.Department of MedicineUniversity College HospitalGalwayIreland
  4. 4.BostonUSA

Personalised recommendations