Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism

Endocrine Surgery Unit, Department of Surgical and Gastroenterology Sciences, University of Padua, School of Medicine, via Giustiniani 2, 35128 Padova, Italy. lumachi@ux1.unipd.it

OBJECTIVE: To evaluate the usefulness of the combination of Tc-sestamibi/Tc-pertechnetate subtraction scintigraphy (SS) and high-resolution neck ultrasonography (US) in patients with primary hyperparathyroidism (pHPT) undergoing parathyroidectomy. DESIGN AND METHODS: Ninety-one patients with proved pHPT were studied, excluding patients with persistent or recurrent disease. There were 65 (71.4%) women and 26 (28.6%) men, with a median age of 59 years (range 18-78 years). All patients underwent both SS and US prior to surgery, and the results were compared with operative and histological findings. The intraoperative quick-parathyroid hormone assay was available for 52 (57.1%) patients. When multiglandular disease was found, both SS and US were considered truly positive only when at least two enlarged parathyroid (PT) glands had been localized. RESULTS: Eighty-three (91.2%) solitary PT adenomas and three (3.3%) carcinomas were found. Moreover, two (2.2%) patients had a double adenoma and three (3.3%) patients had diffuse PT hyperplasia. The overall sensitivity of combined SS+US was 94.5% (86.8% and 80.4% for SS and US respectively). There was a significant (P<0.05, Student's t-test) difference in size between the PT glands correctly identified and undetected by SS, whereas the site of the removed PT tumors significantly (P<0.05, Fisher exact test) influenced only the US sensitivity. CONCLUSIONS: When the preoperative localization of the PT glands is chosen, the combination of SS and US represents a reliable noninvasive localization technique and should be considered for use in each patient with pHPT undergoing surgery.

This article has been cited by other articles:

				H. K. Eslamy and H. A. Ziessman Parathyroid Scintigraphy in Patients with Primary Hyperparathyroidism: 99mTc Sestamibi SPECT and SPECT/CT RadioGraphics, September 1, 2008; 28(5): 1461 - 1476. [Abstract] [Full Text] [PDF]

				N. A. Johnson, M. E. Tublin, and J. B. Ogilvie Parathyroid Imaging: Technique and Role in the Preoperative Evaluation of Primary Hyperparathyroidism Am. J. Roentgenol., June 1, 2007; 188(6): 1706 - 1715. [Abstract] [Full Text] [PDF]

				F Lumachi, M Ermani, F Marino, A Poletti, S. Basso, M Iacobone, and G Favia Relationship of AgNOR counts and nuclear DNA content to survival in patients with parathyroid carcinoma Endocr. Relat. Cancer, September 1, 2004; 11(3): 563 - 569. [Abstract] [Full Text] [PDF]

				F Lumachi, A Tregnaghi, P Zucchetta, M C Marzola, D Cecchin, P Marchesi, F Fallo, and F Bui Technetium-99m sestamibi scintigraphy and helical CT together in patients with primary hyperparathyroidism: a prospective clinical study Br. J. Radiol., February 1, 2004; 77(914): 100 - 103. [Abstract] [Full Text] [PDF]