Skip to main content

Advertisement

SpringerLink
Log in

Sensitivity and Utility of Parathyroid Scintigraphy in Patients with Primary Versus Secondary and Tertiary Hyperparathyroidism

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

Abstract

Introduction

Parathyroid scintigraphy (PS) may be used to localize hyperactive parathyroid glands preoperatively. Performance of PS in the setting of secondary and tertiary hyperparathyroidism (HPT) is not well quantified. The performance of PS in secondary/tertiary HPT versus primary HPT may reflect physiologic as well as radiopharmaceutical kinetic differences between multigland hyperplasia versus adenoma. The aim of this study was to review the performance of PS in secondary/tertiary HPT with a comparison to that for primary HPT. Moreover, we evaluated (1) the sensitivity of PS in detecting enlarged glands, and (2) PS detectability as a function of gland weight.

Methods

We performed a retrospective review of the Mayo Clinic database from 2000 to 2004. We identified 40 patients with secondary or tertiary HPT as well as a matched control group of 40 patients with primary HPT who had had preoperative PS and underwent parathyroid surgery.

Results

Parathyroid scintigraphy correctly localized all enlarged glands in 88% of patients in the primary HPT group. PS correctly identified both the number and locations of all hyperplastic glands in only 28% of the secondary/tertiary HPT patients. PS failed to identify one enlarged gland in 23% of the patients and two or more enlarged glands in 40% of the patients. PS correctly detects the largest gland in 88% of the patients with secondary and tertiary HPT. The mean gland weight detectable by PS was 612 ± 120 mg for primary HPT. In secondary/tertiary HPT, glands detected by PS had a mean weight of 950 ± 109 mg, whereas the mean weight was 276 ± 34 mg for undetected glands (P < 0.002).

Conclusions

Parathyroid scintigraphy is a sensitive study for localizing parathyroid glands preoperatively in primary HPT patients. Its sensitivity is low in secondary and tertiary HPT patients. Thus PS has limited value as a preoperative localization study in secondary/tertiary HPT patients.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Mullan BP. Nuclear medicine imaging of the parathyroid. Otolaryngol Clin North Am 004;37:909–939

    Article  PubMed  Google Scholar 

  2. Berczi C, Mezosi E, Galuska L, et al. Technetium-99m-sestamibi/pertechnetate subtraction scintigraphy vs ultrasonography for preoperative localization in primary hyperparathyroidism. Eur Radiol 2002;12:605–609

    CAS  PubMed  Google Scholar 

  3. Jones JM, Russell CF, Ferguson WR, et al. Pre-operative sestamibi-technetium subtraction scintigraphy in primary hyperparathyroidism: experience with 156 consecutive patients. Clin Radiol 2001;56:556–559

    Article  CAS  PubMed  Google Scholar 

  4. Chen CC, Holder LE, Scovill WA, et al. Comparison of parathyroid imaging with technetium-99m-pertechnetate/sestamibi subtraction, double-phase technetium-99m-sestamibi and technetium-99m-sestamibi SPECT. J Nucl Med 1997;38:834–849

    CAS  PubMed  Google Scholar 

  5. Grant CS, Thompson G, Farley D, et al. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy. Arch Surg 2005;140:472–479

    PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  7. Pons F, Torregrosa JV, Vidal-Sicart S, et al. Preoperative parathyroid gland localization with technetium-99m sestamibi in secondary hyperparathyroidism. Eur J Nucl Med 1997;24:1494–1498

    CAS  PubMed  Google Scholar 

  8. Malmaeus J, Grimelius L, Johansson H, et al. Parathyroid pathology in hyperparathyroidism secondary to chronic renal failure. Scand J Urol Nephrol 1984;18:157–166

    CAS  PubMed  Google Scholar 

  9. Civelek AC, Ozalp E, Donovan P, et al. Prospective evaluation of delayed technetium-99m sestamibi SPECT scintigraphy for preoperative localization of primary hyperparathyroidism. Surgery 2002;131:149–157

    Article  PubMed  Google Scholar 

  10. Zingraff J, Leger A, Skhiri H, et al. Localization of ectopic parathyroid tissue: usefulness of 99mTc sestamibi scanning in a dialysis patient with severe secondary hyperparathyroidism. Nephrol Dial Transplant 1996;11:2504–2506

    CAS  PubMed  Google Scholar 

  11. Neumann DR, Esselstyn CB Jr, Madera A, et al. Parathyroid detection in secondary hyperparathyroidism with 123I/99mTc-sestamibi subtraction single photon emission computed tomography. J Clin Endocrinol Metab 1998;83:3867–3871

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, 200 Second Street SW, Rochester, Minnesota, 55901, USA

    Tuan H. Pham MD, PhD, Sylvester Sterioff MD & Clive S. Grant MD

  2. Department of Nuclear Medicine, Mayo Clinic, 200 Second Street SW, Rochester, Minnesota, 55901, USA

    Brian P. Mullan MD & Gregory A. Wiseman MD

  3. Department of Pathology, Mayo Clinic, 200 Second Street SW, Rochester, Minnesota, 55901, USA

    Thomas J. Sebo MD

Authors
  1. Tuan H. Pham MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sylvester Sterioff MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brian P. Mullan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gregory A. Wiseman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas J. Sebo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Clive S. Grant MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sylvester Sterioff MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pham, T.H., Sterioff, S., Mullan, B.P. et al. Sensitivity and Utility of Parathyroid Scintigraphy in Patients with Primary Versus Secondary and Tertiary Hyperparathyroidism. World J. Surg. 30, 327–332 (2006). https://doi.org/10.1007/s00268-005-0279-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-005-0279-3

Keywords

Search

Navigation