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Negative Imaging Studies for Primary Hyperparathyroidism Are Unavoidable: Correlation of Sestamibi and High-Resolution Ultrasound Scanning with Histological Analysis in 150 Patients

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Abstract

Background

Preoperative localization studies with Tc99m-sestamibi have become an integral step in the preoperative assessment of patients with primary hyperparathyroidism (PHPT). This enables scan-directed minimally invasive parathyroidectomy (MIP) to be the preferred treatment for PHPT in many units. This study aimed to identify factors that lead to negative imaging studies in patients with PHPT.

Methods

Over a 3-year period consecutive unselected patients with PHPT underwent Tc99m-sestamibi scanning and high-resolution ultrasound (US) scanning by the same radiologist. When localization studies were concordant, patients underwent MIP. Those patients with negative imaging studies underwent bilateral neck exploration. Histology slides were independently reviewed and the proportion of chief cells and oxyphil cells within each adenoma was estimated.

Results

One hundred and fifty-eight patients underwent localization studies (38 men and120 women, aged 61.8 ± 15.2 years). Sestamibi scans were negative in 52 (32%) and positive in 106 (68%) patients. There was a higher incidence of hyperplasia in the group of patients with negative sestamibi scans (4 out of 52 vs. 4 out of 103, P < 0.05, χ2 test). In patients with negative sestamibi scans the majority of adenomas were formed predominantly from chief cells (26 out of 36) while the majority of patients with adenomas composed predominantly of oxyphil cells had positive scans (21 out of 23) (P < 0.05, χ2 test). The weight of parathyroid adenomas was higher when sestamibi scans were positive (median: 1,180 vs. 517 mg, P < 0.05, Student’s t-test).

Conclusion

Successful preoperative localization of parathyroid adenomas using Tc99m-sestamibi scanning is influenced by the cytological predominance of individual tumors. Negative scans might therefore be unavoidable in a subgroup of patients.

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References

  1. Adami S, Marcocci C, Gatti D. Epidemiology of primary hyperparathyroidism in Europe. J Bone Miner Res 2002;17(Suppl 2):N18–N23

    PubMed  Google Scholar 

  2. Melton LJ III. Epidemiology of primary hyperparathyroidism. J Bone Miner Res 1991;6(Suppl 2):S25–S30

    Article  PubMed  Google Scholar 

  3. Doppman J. Reoperative parathyroid surgery: localization procedures, parathyroid surgery. Prog Surg 1986;18:117

    Google Scholar 

  4. Denham DW, Norman J. Cost-effectiveness of preoperative sestamibi scan for primary hyperparathyroidism is dependent solely upon the surgeon’s choice of operative procedure. J Am Coll Surg 1998;186:293–305

    Article  CAS  PubMed  Google Scholar 

  5. Coackley AJ, Kettle AG, Wells CP, et al. 99Tc-sestamibi: a new agent for parathyroid imaging. Nucl Med Commun 1989;10:791–794

    Google Scholar 

  6. Arbab AS, Koizumi K, Toyama K, et al. Uptake of technetium-99m-tetrofosmin, technetium-99, -MIBI and thalium-201 in tumour cell lines. J Nucl Med 1996;37:1551–1556

    CAS  PubMed  Google Scholar 

  7. Hetrakul N, Civelek AC, Sragg CA, et al. In vitro accumulation of technetium-99m-sestamibi in human parathyroid mitochondria. Surgery 2001;130:1011–1018

    Article  CAS  PubMed  Google Scholar 

  8. O’Doherty MJ, Kettle AG, Wells P, et al. Parathyroid imaging with technetium-99m-sestamibi: preoperative localization and tissue uptake studies. J Nucl Med 1992;33:313–318

    CAS  PubMed  Google Scholar 

  9. Kao A, Shiau YC, Tsai SC, et al. Technetium-99m methoxyisobutylisonitrile imaging for parathyroid adenoma: relationship to P-glycoprotein or multidrug resistance-related protein expression. Eur J Nucl Med Mol Imaging 2002;29:1012–1015

    Article  CAS  PubMed  Google Scholar 

  10. Sun SS, Shiau YC, Lin CC, et al. Correlation between P-glycoprotein (P-gp) expression in parathyroid and Tc-99m-MIBI parathyroid image finding. Nucl Med Biol 2001;28:929–933

    Article  CAS  PubMed  Google Scholar 

  11. Taillefer R, Robidoux A, Lambert R, et al. Technetium-99m-sestamibi prone scintimammography to detect primary breast cancer and axillary lymph node involvement. J Nucl Med 1995;36:1758–1765

    CAS  PubMed  Google Scholar 

  12. Yen TC, Tzen KY, Lee CM, et al. Squamous cell carcinoma of the lung mimicking an ectopic mediastinal parathyroid adenoma demonstrated by Tc-99m sestamibi in a hypercalcaemic patient. Clin Nucl Med 1999; 24:895–896

    Article  CAS  PubMed  Google Scholar 

  13. Glaser C, Pruckmayer M, Staudenherz A, et al. Utility of technetium-99m-sestamibi to assess osseous tumour spread. J Nucl Med 1996;37:1526–1528

    CAS  PubMed  Google Scholar 

  14. Kos WGM, Brown MR, Balfour JF. A false-positive localization of parathyroid adenoma with technetium Tc99m-sestamibi secondary to a thyroid follicular carcinoma. Arch Surg 1996;131:216–217

    Google Scholar 

  15. Scott AM, Kostakoglu L, O’Brien JP, et al. Comparison of technetium-99m-MIBI and thalium-201-chloride uptake in primary thyroid lymphoma. J Nucl Med 1992;33:1396–1398

    CAS  PubMed  Google Scholar 

  16. Leslie WD, Riese KT, Mohamed C. Sestamibi retention in reactive lymph node hyperplasia: a cause of false-positive parathyroid localisation. Clin Nucl Med 2000;25:216–217

    Article  CAS  PubMed  Google Scholar 

  17. Mudun A, Kocak M, Unal S, Cantez S, et al. Tc99m MIBI accumulation in remnant thymus: a cause of false-positive interpretation in parathyroid imaging. Clin Nucl Med 1995;20:379–380

    Article  CAS  PubMed  Google Scholar 

  18. Campeau RJ, Reuther WL, Wayne J. False-positive Tc99m sestamibi examination for parathyroid adenoma in a case of asymmetrical salivary gland enlargement. Clin Nucl Med 1999;24:723–724

    Article  CAS  PubMed  Google Scholar 

  19. Perez-Monte JE, Brown ML, Clarke MR, et al. Parathyroid hyperplasia, thymic carcinoid and pituitary adenoma detected with technetium 99m-MIBI in MEN type I. J Nucl Med 1997;38:1767–1769

    CAS  PubMed  Google Scholar 

  20. Pattou F, Huglo D, Proye C. Radionuclide scanning in parathyroid diseases. Br J Surg 1998;85:1605–1616

    Article  CAS  PubMed  Google Scholar 

  21. Leslie WD, Dupont JO, Bybel B, et al. Parathyroid (99m)Tc-sestamibi scintigraphy: dual tracer subtraction is superior to double-phase washout. Eur J Nucl Med Mol Imaging 2002;29:1566–1570

    Article  PubMed  Google Scholar 

  22. Moka D, Voth E, Dietlein M, et al. Technetium 99m-MIBI-SPECT: a highly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery 2000;128:29–35

    Article  CAS  PubMed  Google Scholar 

  23. Royal RE, Delpassand ES, Shapiro SE, et al. Improving the yield of preoperative localisation: technetium Tc 99m-sestamibi imaging after thyroid suppression. Surgery 2002;132:968–975

    Article  PubMed  Google Scholar 

  24. Lumachi F, Zucchetta P, Marzola MC, et al. Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism. Eur J Endocrinol 2000;143:755–760

    Article  CAS  PubMed  Google Scholar 

  25. Casara D, Rubello D, Piotto A, et al. (99m)Tc-MIBI radio-guided minimally invasive parathyroid surgery planned on the basis of preoperative combined (99m)Tc-pertechnetate/(99m)TC-MIBI and ultrasound imaging protocol. Eur J Nucl Med 2000;27:1300–1304

    Article  CAS  PubMed  Google Scholar 

  26. Purcell GP, Dirbas FM, Jeffrey RB, et al. Parathyroid localization with high-resolution ultrasound and technetium Tc99m-sestamibi. Arch Surg 1999;134:824–830

    Article  CAS  PubMed  Google Scholar 

  27. DeLellis RA. Surgical pathology of the parathyroid glands. In Randolph G, editor, Surgery of the Thyroid and Parathyroid Glands, St. Louis, MI, Elsevier, 2003;571–577

    Google Scholar 

  28. Melloul M, Paz A, Koren R, Cytron S, et al. (99m)-TC-MIBI scintigraphy of parathyroid adenomas and its relation to tumour size and oxyphil cell abundance. Eur J Nucl Med 2001;28:209–213

    Article  CAS  PubMed  Google Scholar 

  29. Carpentier A, Jeannotte S, Verreault J, et al. Preoperative localization of parathyroid lesions in hyperparathyroidism: relationship between technetium 99m-MIBI uptake and oxyphil cell content. J Nucl Med 1998;39(8):1441–1444

    CAS  PubMed  Google Scholar 

  30. Staudenherz A, Abela C, Niederle B, et al. Comparison and histopathological correlation of three parathyroid imaging methods in a population with a high prevalence of concomitant thyroid disease. Eur J Nucl Med 1997;24:143–149

    CAS  PubMed  Google Scholar 

  31. Bhatnagar A, Vezza PR, Bryan JA, et al. Technetium 99m-sestamibi parathyroid scintigraphy: effect of P-glycoprotein, histology and tumour size on detectability. J Nucl Med 1998;39:1617–1620

    CAS  PubMed  Google Scholar 

  32. Ugur O, Bozkurt MF, Hamaloglu E, et al. Clinicopathologic and radiopharmacokinetic factors affecting gamma-probe-guided parathyroidectomy. Arch Surg 2004;139:1175–1179

    Article  PubMed  Google Scholar 

  33. Westreich RW, Brandwein M, Mechanick JI, et al. Preoperative parathyroid localization: correlating false-negative technetium-99m-sestamibi scans with parathyroid disease. Laryngoscope 2003;113:567–572

    Article  PubMed  Google Scholar 

  34. Mehta NY, Ruda JM, Kapadia S, et al. Relationship of technetium-99m sestamibi scans to histopathological features of hyperfunctioning parathyroid tissue. Arch Otol Head Neck Surg 2005;131:493–498

    Article  Google Scholar 

  35. Flynn MB, Bumpous JM, Schill K, et al. Minimally invasive radioguided parathyroidectomy. J Am Coll Surg 2000;191:24–31

    Article  CAS  PubMed  Google Scholar 

  36. Saint Marc O, Cogliandolo A, Pidoto RR, et al. Prospective evaluation of ultrasonography plus MIBI scintigraphy in selecting patients with primary hyperparathyroidism for unilateral neck exploration under local anaesthesia. Am J Surg 2004;187:388–393

    Article  PubMed  Google Scholar 

  37. Jacobson SR, van Heerden JA, Farley DR, et al. Focused cervical exploration for primary hyperparathyroidism without intraoperative parathyroid hormone monitoring or use of the gamma probe. World J Surg 2004;28:1127–1131

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Endocrine Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 7LJ, UK

    Radu Mihai MD, PhD, FRCS & Gregory P. Sadler MD, FRCS (Ed), FRCS Gen Surg (Eng)

  2. Department of Radiology, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 7LJ, UK

    Fergus Gleeson FRCR, FRCP

  3. Department of Pathology, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 7LJ, UK

    Ian D. Buley MA, BM, BCh, FRCPath & Derek E. Roskell MA, BM, BCh, FRCPath

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  1. Radu Mihai MD, PhD, FRCS
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  2. Fergus Gleeson FRCR, FRCP
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  3. Ian D. Buley MA, BM, BCh, FRCPath
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  4. Derek E. Roskell MA, BM, BCh, FRCPath
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  5. Gregory P. Sadler MD, FRCS (Ed), FRCS Gen Surg (Eng)
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Correspondence to Gregory P. Sadler MD, FRCS (Ed), FRCS Gen Surg (Eng).

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Mihai, R., Gleeson, F., Buley, I.D. et al. Negative Imaging Studies for Primary Hyperparathyroidism Are Unavoidable: Correlation of Sestamibi and High-Resolution Ultrasound Scanning with Histological Analysis in 150 Patients. World J. Surg. 30, 697–704 (2006). https://doi.org/10.1007/s00268-005-0338-9

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