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

Abstract

Parathyroid scintigraphy and high-resolution ultrasonography are frequently used as preoperative localization procedures in primary hyperparathyroidism. However, when thyroid disease coexists, their diagnostic accuracy is probably abated. DESIGN: 56 patients with primary hyperparathyroidism were prospectively evaluated with parathyroid scintigraphy (with either thallium or technetium-99m agents or both) and 44 of them were also evaluated with ultrasonography. RESULTS: 33 patients (59%) had coexistent thyroid disease. Upon operation, 48 patients were found to have a solitary parathyroid adenoma and were all cured. One patient had a carcinoma and 7 had multiglandular parathyroid disease. Regarding solitary lesions, the sensitivity of parathyroid scintigraphy with Tc-agents was 97% and thallium 78%, while that of ultrasonography was 74%. The false positive rate was 2.6%, 18% and 22%, respectively. Concomitant thyroid disease had a non-significant effect on the results of parathyroid scintigraphy and ultrasonography. The efficiency of both modalities in diagnosing multiglandular disease was low (only 3/7 patients, 43%). CONCLUSIONS: Parathyroid scintigraphy, in conjunction with Sestamibi or Tetrofosmin, constitutes the most sensitive localizing technique as regards solitary lesions. Ultrasonography is also useful in confirming scintigraphic findings, offers more precise anatomic information, and is valuable in the evaluation of concomitant thyroid disease. The complementary use of parathyroid scintigraphy and ultrasonography is beneficial and efficacious in areas with high prevalence of thyroid disease. The value of these modalities is considerably lower in multiglandular disease.

Imaging diagnostics for primary hyperparathyroidism

“…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].…”

“…iodine J123 or Tc99m pertechnet, and the picture is 'subtracted' from the one obtained upon administration of Technet99m sestamibi [46,47]; -three-dimensional examinations SPECT (Single Photon Emission Computed Tomography) [5,38,48]. Using USG together with Tc99sestamibi enables the examiner to obtain higher sensitivity of the picture from 10% to even 30% [13]. Statistical analyses have revealed that further independent factors affecting the accuracy of the two diagnostic tests are body mass index (BMI) and the size of the thyroid gland [8].…”

“…In light of the above, imaging examinations of parathyroid glands should be: -highly sensitive -highly specific -as minimally invasive as possible -cost-effective -available [13].…”

Primary hyperparathyroidism: can ultrasonography be the only preoperative diagnostic procedure?

“…L'incidenza di questa patologia nella popolazione generale è stimata in 40/100000 casi all'anno ed è 4-5 volte maggiore nelle donne dopo la menopausa [1][2][3]. La terapia d'elezione è quella chirurgica di paratiroidectomia.…”

“…The estimated incidence of this disorder in the general population is 40/100,000 cases per year and is four to five times higher among postmenopausal women [1][2][3]. The treatment of choice is surgical parathyroidectomy.…”