Preoperative Localization of Parathyroid Adenoma in Patients with Concomitant Thyroid Nodular Disease

Abstract

We have previously demonstrated the role of high-resolution ultrasonography (US) in preoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism (PHPT) and no thyroid abnormalities. The present study prospectively evaluated the possible additional value of 99mTc-sestamibi (MIBI) in patients with PHPT and concomitant multinodular thyroid disease (MND). Patients with PHPT underwent US and MIBI scintigraphy prior to neck exploration. Imaging data were correlated with the site and pathology of the parathyroid tissue removed and were analyzed separately for patients with MND and those with a normal thyroid gland. Among 77 patients with a solitary parathyroid adenoma at surgery, 40 had concomitant MND, whereas 37 patients had no morphologic changes in the thyroid gland, on US or at surgery. Prior to surgery, MIBI scintigraphy depicted 58 of the 77 adenomas (75%) and US localized 51 (66%): the combined sensitivity was 87% (67/77). Among the 37 patients with no thyroid nodules, MIBI located 29 (78%) and US identified 30 (81%) of the adenomas; the combined sensitivity was 89%. In the 40 patients with MND, MIBI identified 29 adenomas (73%) and US localized only 53% (21/40); the combined sensitivity was 85%. Overall, the positive predictive value (PPV) of MIBI for detecting a solitary parathyroid adenoma was 94%, for US it was 88%, and with the two tests combined it was 97%. In patients with no thyroid abnormalities, the PPV of MIBI and US was 97%, but it decreased to 91% and 78%, respectively, in patients with MND. Two patients with false-positive findings on both MIBI and US had associated thyroid disease. Hence MIBI scintigraphy contributes to localization of a solitary parathyroid adenoma mainly in patients with concomitant MND. The combined MIBI and US modalities result in sparing these patients bilateral neck exploration.

The value of scintigraphy and ultrasonography in the preoperative localization of parathyroid glands in patients with primary hyperparathyroidism and concomitant thyroid disease

“…However, a number of parathyroid lesions show rapid washout of MIBI and, consequently, a gain in specificity would result in a loss of sensitivity. 11,16,21 We cannot draw conclusions from the present study on this issue, because the results of the double phase technique were not interpreted blinded to the subtraction method, while the corresponding findings were not reported separately.…”

“…[7][8][9][10][11][12] Lower detection rates have been reported for both US and scintigraphy in the presence of thyroid disease or in cases of previous neck surgery. [10][11][12][13] Both false negative and false positive results have been related to coexistent thyroid abnormalities. On the other hand, preoperative identification of concomitant thyroid disease is important, because surgical treatment of both thyroid and parathyroid disease can be undertaken at the same time.…”

Traitement Chirurgical De L\'hyperparathyroidie Primaire : Techniques Et Resultats

“…L'échographie parathyroidienne utilise un échographe de haute résolution adapté à la détection de tissu superficiel [6]. Seules les glandes de diamètre supérieur à 5 mm sont détectables [7,8,9]. Sa sensibilité varie dans la littérature de 55 à 85% [3,5,6,8].…”

“…Seules les glandes de diamètre supérieur à 5 mm sont détectables [7,8,9]. Sa sensibilité varie dans la littérature de 55 à 85% [3,5,6,8]. Dans notre série, elle était de 60%.…”

“…L'hypocalcémie post-opératoire peut n'être que transitoire et se normaliser au fil des jours ou des mois. Le risque d'hypoparathyroïdie définitive varie de 0 à 11,5% [2,6,8]. Dans notre série, il était de 8,8%.…”