Background
Unilateral neck exploration (UNE) is becoming the procedure of choice for treatment
of primary hyperparathyroidism (PHPT). The aim of this study was to evaluate the role
of 99mTc-sestamibi (MIBI) parathyroid scintigraphy as the sole technique in selecting patients
for UNE.
Method
We selected 136 consecutive PHPT patients who had only 1 solitary uptake at a MIBI
were for UNE. The technique was a single dual-phase using MIBI and a subtraction technique
with 99mTc-pertechnetate. Imaging data were correlated with surgical results.
Results
In 3 cases, the sestamibi scan was falsely positive, 1 had a contralateral location
relative to the uptake, and 2 had multiglandular hyperplasia. Overall, the positive
predictive value (PPV) of MIBI for detecting a solitary parathyroid adenoma in patients
with 1 solitary uptake was 97.8. Sixteen patients (12%) had evidence of multinodular
goiter. Overall, the PPV of MIBI was 98.4% (2 false positive among 120 cases) in patients
with no multinodular thyroid disease (MNG) and 93.7% (1 false negative among 16 cases)
in patients with MNG. The mean duration of the surgical procedure was 34.17 minutes.
Mean hospitalization was 0.6 days. Conversion to bilateral neck exploration was performed
in 5 patients. After a period of follow-up of 40 months (range, 6–72 months), the
cure rate was 98%.
Conclusion
Patients with PHPT and unequivocally positive preoperative 99mTc-sestamibi can safely be managed with UNE without additional localizing techniques.
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Article info
Publication history
Accepted:
May 20,
2008
Footnotes
Supported by grant PIO 42257 from the Fondo de Investigación Sanitaria.
Identification
Copyright
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
