Abstract
Background. In an effort to determine an efficient algorithm for the evaluation of patients with
parathyroid adenomas in the reoperative setting, we explored the combination of using
ultrasound scans (US) and sestamibi scintigraphy as the only preoperative imaging
tests. Methods. We analyzed the outcomes of 62 consecutive patients who were treated between January
1995 and May 1999 and who were referred for persistent primary hyperparathyroidism
after initial surgical exploration, at which time no abnormal parathyroid glands had
been found. Although all patients underwent US, computed tomography scan, magnetic
resonance imaging, and sestamibi scan, we analyzed the success of localization and
reoperation using only the results of US and sestamibi scan. Results. Sixty-one patients (98%) underwent curative reoperations. The sensitivity, positive
predictive value, and accuracy for US were 90%, 86%, and 84%, respectively; the corresponding
values for sestamibi imaging were 78%, 94%, and 74%, respectively. In 58 of 62 cases
(94%) preoperative US and/or sestamibi scan accurately identified the adenoma. In
3 patients for whom combined US and sestamibi scan were inaccurate, 1 adenoma was
found by intraoperative US in the strap muscle; 1 adenoma was found by blind cervical
thymectomy, and 1 adenoma was found by planned sternotomy that was based on computed
tomography findings. Conclusions. This study supports an algorithm of obtaining US and sestamibi scan as the initial
and perhaps only preoperative localization tests for patients with primary hyperparathyroidism
after failed operation, at which time no abnormal glands had been found. (Surgery
2000;128:1103-10.)
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Article info
Footnotes
*Reprint requests: David L. Bartlett, MD, Surgery Branch, National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Bldg 10, Room 2B16, Bethesda, MD 20892.
**Surgery 2000;128:1103-10.
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
