Abstract
Background
There are conflicting data in the literature about the sensitivity of sestamibi scintigraphy in parathyroid tumour localisation in primary hyperparathyroidism (PHPT).
Aim
We aimed to evaluate the overall sensitivity of this modality in parathyroid tumour localisation and to determine clinical and biochemical factors which influence sensitivity of this method.
Methods
We performed a retrospective review of 57 patients with a biochemical diagnosis of PHPT who had sestamibi scintigraphy performed.
Results
The sensitivity of sestamibi scanning was 56% in whole group and 63% in those without nodular thyroid disease. Among the patients with confirmed single gland disease (biochemical cure after surgical removal of a single adenoma), sensitivity was 71%. A positive scan was associated with younger age, greater adenoma weight and higher pre-operative serum calcium. Concordance between the sestamibi and neck ultrasonography was 92% accurate in pre-operative tumour localisation.
Conclusion
Sestamibi scintigraphy was more likely to be positive in younger patients without nodular thyroid disease who have larger parathyroid adenomas with more severe hyperparathyroidism.
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References
Heath H 3rd, Hodgson SF, Kennedy MA (1980) Primary hyperparathyroidism. Incidence, morbidity, and potential economic impact in a community. N Engl J Med 302(4):189–193
Russell CF, Edis AJ (1982) Surgery for primary hyperparathyroidism: experience with 500 consecutive cases and evaluation of the role of surgery in the asymptomatic patient. Br J Surg 69(5):244–247
Bilezikian JP, Silverberg SJ (2000) Clinical spectrum of primary hyperparathyroidism. Rev Endocr Metab Disord 1(4):237–245
Kaplan EL, Yashiro T, Salti G (1992) Primary hyperparathyroidism in the 1990s. Choice of surgical procedures for this disease. Ann Surg 215(4):300–317
Udelsman R, Pasieka JL, Sturgeon C, Young JE, Clark OH (2009) Surgery for asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab 94(2):366–372
Gotthardt M, Lohmann B, Behr TM et al (2004) Clinical value of parathyroid scintigraphy with technetium-99m methoxyisobutylisonitrile: discrepancies in clinical data and a systematic metaanalysis of the literature. World J Surg 28(1):100–107
Taillefer R, Boucher Y, Potvin C, Lambert R (1992) Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium-99m-sestamibi (double-phase study). J Nucl Med 33(10):1801–1807
Allendorf J, Kim L, Chabot J, DiGiorgi M, Spanknebel K, LoGerfo P (2003) The impact of sestamibi scanning on the outcome of parathyroid surgery. J Clin Endocrinol Metab 88(7):3015–3018
Hindie E, Melliere D, Perlemuter L, Jeanguillaume C, Galle P (1997) Primary hyperparathyroidism: higher success rate of first surgery after preoperative Tc-99m sestamibi-I-123 subtraction scanning. Radiology 204(1):221–228
Moure D, Larranaga E, Dominguez-Gadea L et al (2008) 99MTc-sestamibi as sole technique in selection of primary hyperparathyroidism patients for unilateral neck exploration. Surgery 144(3):454–459
Coakley AJ, Kettle AG, Wells CP, O’Doherty MJ, Collins RE (1989) 99Tcm sestamibi—a new agent for parathyroid imaging. Nucl Med Commun 10(11):791–794
Civelek AC, Ozalp E, Donovan P, Udelsman R (2002) Prospective evaluation of delayed technetium-99m sestamibi SPECT scintigraphy for preoperative localization of primary hyperparathyroidism. Surgery 131(2):149–157
Pappu S, Donovan P, Cheng D, Udelsman R (2005) Sestamibi scans are not all created equally. Arch Surg 140(4):383–386
Thomas DL, Bartel T, Menda Y, Howe J, Graham MM, Juweid ME (2009) Single photon emission computed tomography (SPECT) should be routinely performed for the detection of parathyroid abnormalities utilizing technetium-99m sestamibi parathyroid scintigraphy. Clin Nucl Med 34(10):651–655
Hindie E, Melliere D, Jeanguillaume C, Perlemuter L, Chehade F, Galle P (1998) Parathyroid imaging using simultaneous double-window recording of technetium-99m-sestamibi and iodine-123. J Nucl Med 39(6):1100–1105
Biertho LD, Kim C, Wu HS, Unger P, Inabnet WB (2004) Relationship between sestamibi uptake, parathyroid hormone assay, and nuclear morphology in primary hyperparathyroidism. J Am Coll Surg 199(2):229–233
Bandeira FA, Oliveira RI, Griz LH, Caldas G, Bandeira C (2008) Differences in accuracy of 99mTc-sestamibi scanning between severe and mild forms of primary hyperparathyroidism. J Nucl Med Technol 36(1):30–35
Tublin ME, Pryma DA, Yim JH et al (2009) Localization of parathyroid adenomas by sonography and technetium Tc 99m sestamibi single-photon emission computed tomography before minimally invasive parathyroidectomy: are both studies really needed? J Ultrasound Med 28(2):183–190
Gotway MB, Reddy GP, Webb WR, Morita ET, Clark OH, Higgins CB (2001) Comparison between MR imaging and 99mTc MIBI scintigraphy in the evaluation of recurrent of persistent hyperparathyroidism. Radiology 218(3):783–790
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Glynn, N., Lynn, N., Donagh, C. et al. The utility of 99mTc-sestamibi scintigraphy in the localisation of parathyroid adenomas in primary hyperparathyroidism. Ir J Med Sci 180, 191–194 (2011). https://doi.org/10.1007/s11845-010-0641-9
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DOI: https://doi.org/10.1007/s11845-010-0641-9