Are Additional Localization Studies and Referral Indicated for Patients With Primary Hyperparathyroidism Who Have Negative Sestamibi Scan Results?

Elaraj, Dina M.; Sippel, Rebecca S.; Lindsay, Sheila; Sansano, Ileana; Duh, Quan Yang; Clark, Orlo H.; Kebebew, Electron

doi:10.1001/archsurg.2010.108

Cited by 65 publications

(56 citation statements)

References 18 publications

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“…It is also important that the requisition form has been properly completed, giving full information not only on the history but also on laboratory findings. The quality of the picture is important too [13][14][15][16].…”

Section: Szkolenie Podyplomowementioning

confidence: 99%

Imaging diagnostics for primary hyperparathyroidism

Gawrychowski¹,

Buła²

2013

Endokrynologia Polska

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Primary hyperparathyroidism (PHP) is a benign condition characterised by malignant potential. Even in specialist wards, 5-10% of operations for PHP are unsuccessful. The main reasons seem to be ectopy of the parathyroid gland, numerous adenomas, multiglandular parathyroid hyperplasia, and intrathyroid location of the parathyroid. The last three decades have witnessed a rapid progression in imaging diagnostics.

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Section: Szkolenie Podyplomowementioning

confidence: 99%

Imaging diagnostics for primary hyperparathyroidism

Gawrychowski¹,

Buła²

2013

Endokrynologia Polska

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“…Then again, it does reflect the ability to achieve a good surgical success rate in a modest volume setting even in MIBI "negative" patients. The observed surgical success rate in a modest volume institution contradicts the conclusions from others to treat MIBI "negative" patients only in high volume institutions [20]. Furthermore we did not investigate the contemporary use of SPECT or SPECT/CT, however MIBI is a readily available technique and was used in our hospital in the past decade.…”

Section: Discussionmentioning

confidence: 56%

Additional Imaging Following a Negative Sestamibi Scan in Primary Hyperparathyroidism

Twigt¹,

Vollebregt²,

Hooge³

et al. 2012

IJOHNS

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Background: The objective of this study was to assess the additional yield of US and CT following a "negative" initial MIBI-scintigraphy (MIBI) in patients with primary hyperparathyroidism. Methods: Prospective data were collected regarding 100 consecutive patients, preferentially undergoing a minimally invasive parathyroidectomy (MIP). MIBI was the initial imaging study for localizing a solitary adenoma, followed by US and CT (US/CT) in "MIBI-negative"-patients. Results: Surgery led to normocalcemia in 98 patients (98%) after one operation. Overall 97 patients had solitary parathyroid disease while three patients had multiglandular disease. The sensitivity of imaging increased from 74% for MIBI alone to 92% following subsequent US/CT in "MIBI-negative"-patients. The positive predictive value of a "positive" MIBI was 96% and 76% of a positive US/CT following negative MIBI. The proportion of patients who underwent successful MIP increased from 60 to 72%. Conclusions: MIBI and the combination of US and CT are complementary imaging studies. Additional localization studies after a negative sestamibi scan enhances the number of patients with primary hyperparathyroidism profiting from a minimally invasive approach.

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“…This final question relates to the impact on surgical outcome. As mentioned above, the success of surgery consisting of bilateral neck exploration is suboptimal in patients with a negative sestamibi scan (close to 90%) [14,15,28]. Based on the results of 18 F-fluorocholine PET/CT imaging in the series by Quak et al, 18 of 24 patients were able to receive targeted surgery, which is interesting.…”

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confidence: 99%

“…Some recent studies have shown significant differences in surgical cure rates between patients with a negative sestamibi scan receiving bilateral neck exploration and those with a positive sestamibi scan (e.g. 89% vs. 97%, P = 0.008 [14]; and 90.4% vs. 97.5%, P < 0.001 [15]). It has also been found that patients with a negative sestamibi scan are less likely to be referred to the surgeon [16].…”

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confidence: 99%

“…Detection of only one lesion increases the likelihood of intraoperative conversion to bilateral exploration, or of surgical failure if intraoperative PTH (iOPTH) assessment is not available [27]. Patients with a negative sestamibi scan have much higher rates of MGD at surgery than those with a positive scan [14,15]; for example, 32% vs. 13% (P < 0.001) in the series by Dy et al [15]. The finding of only one patient with MGD on choline PET in the series by Quak et al raises the question as to the sensitivity for MGD detection [13].…”

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confidence: 99%

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