Use of Technetium Tc 99m Sestamibi and Iodine 123 Radionuclide Scan for Preoperative Localization of Abnormal Parathyroid Glands in Primary Hyperparathyroidism

Dj, Halvorson; Gj, Burke; Ar, Mansberger; Jp, Wei

doi:10.1097/00007611-199403000-00007

Cited by 20 publications

(5 citation statements)

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“…In contrast to the wide range of sensitivity data, the specificity and PPV for both MIBI techniques are above 90% [33,34]. Several studies have reported 100% PPV [13,30,33,34], whereas others found false-positive scans [2,4,9,12,19,24,[35][36][37][38].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2000

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2000

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“…The technetium Tc 99m sestamibi scan is a widely used and accepted localization modality, having been conceived initially by Coakley et al 7 in 1987 and applied clinically from 1992 to the present. Most adequate series 4,5,[8][9][10][11][12][13] report an 85% to 90% success rate in adenoma localization. In 1996, Sofferman et al 6 reported experience with 33 scans and demonstrated a 90% sensitivity, including accurate preoperative identification of the double and ectopic adenomas.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, if a single adenoma is identified and removed with confirmation, by pathological examination of a frozen section, of a normal second ipsilateral gland, the chance that a second adenoma will be missed is extremely low. 4,9,12 Likewise, 1 adenomatous and 1 normal gland confirmed by examination of a frozen section likely excludes diffuse parathyroid hyperplasia. By using technetium Tc 99m sestamibi scan and this method of pathological assay, only 2 frozen sections are required, rather than the traditional 4-gland assay with bilateral nonimaged exploration.…”

Section: Methodsmentioning

confidence: 99%

The Ectopic Parathyroid Adenoma

Sofferman

Nathan²

1998

Arch Otolaryngol Head Neck Surg

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“…The medical literature contains numerous studies that support a unilateral approach with preoperative imaging, whereas others recommend bilateral exploration exclusively, with or without imaging. 3,[5][6][7][8][9][10][11][12][13] We have addressed this difference of opinion by retrospectively reviewing all neck explorations performed for primary hyperparathyroidism during a 77-month period (January 1990 to May 1996) by 2 surgeons of the Head and Neck Associates at Swedish Medical Center in Seattle, WA. Preoperative imaging studies were analyzed for accuracy in predicting surgical findings.…”

mentioning

confidence: 99%

“…Imaging modalities that have been used with varying success include high‐resolution ultrasonography, MRI, CT scanning, and nuclear scintigraphy. The medical literature contains numerous studies that support a unilateral approach with preoperative imaging, whereas others recommend bilateral exploration exclusively, with or without imaging 3,5‐13 …”

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confidence: 99%

Success of Preoperative Imaging and Unilateral Neck Exploration for Primary Hyperparathyroidism

Song

Phillips

Edmond

et al. 1999

Otolaryngol.--head neck surg.

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The surgical treatment of hyperparathyroidism has become controversial with the recent advent of reliable preoperative imaging modalities. This study examines the efficacy and economy of using preoperative imaging studies to localize the pathology and allow for unilateral neck exploration. From January 1990 to May 1996, a total of 91 patients with primary hyperparathyroidism were treated at Swedish Medical Center in Seattle, WA, by 2 surgeons. Eighty-six nuclear scintigraphy studies were performed, of which 44 were technetium 99m sestamibi (Tc-99m-sestamibi) scans and 42 were thallium 99m technetium (Th-99m-Tc) scans. The overall sensitivity for Tc-99m-sestamibi was 91% (40/44), and that for Th-99m-Tc scans was 81% (34/42). Ultrasound examination revealed a sensitivity of 80% (66/82). There was a statistically significant difference in surgical time between the unilateral and bilateral neck explorations (45 minutes, P < 0.0001). Unilateral neck exploration for hyperparathyroidism has been successful in curing hypercalcemia 93% (85/91) of the time with the use of preoperative imaging studies. Tc-99m-sestamibi is a reliable tool for planning the initial unilateral neck exploration for treatment of primary hyperparathyroidism.

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Use of Technetium Tc 99m Sestamibi and Iodine 123 Radionuclide Scan for Preoperative Localization of Abnormal Parathyroid Glands in Primary Hyperparathyroidism

Cited by 20 publications

References 0 publications

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

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

The Ectopic Parathyroid Adenoma

Success of Preoperative Imaging and Unilateral Neck Exploration for Primary Hyperparathyroidism

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