title: The role of pre-operative thallium-technetium subtraction scintigraphy in the surgical management of patients with solitary parathyroid adenoma.
abstract: Since 1985 we have practised scan directed unilateral cervical exploration for patients with primary hyperparathyroidism (HPT) on the basis of a solitary parathyroid adenoma, and who had a pre-operative thallium-technetium subtraction scintigram demonstrating one focus of activity (positive scan). Between 1985 and 1993, a total of 160 patients with proven HPT and a technically satisfactory scintigram underwent neck exploration. Of these, 96 had positive preoperative scans, 81 (84.4%) of which accurately predicted the site of the tumour subsequently retrieved at operation. Seventy-four (77.6%) with positive scans, and 80 of the entire group, underwent unilateral cervical exploration with removal of a presumed single adenoma. Seventy-eight (97.5%) of these patients were cured of their HPT; two patients demonstrated mild persistent hypercalcaemia. Median operating time was significantly reduced for patients having unilateral as opposed to bilateral operation. Our results suggest that, when positive, thallium-technetium subtraction scintigraphy will accurately predict the site of a solitary parathyroid adenoma in a high proportion of patients and will thus permit a unilateral parathyroid exploration in these individuals. The usefulness of the technique is limited by its low sensitivity for small tumours.
authors.affiliation: Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK.
authors.forename: E
authors.initials: E
authors.lastname: Tsukamoto
authors.forename: C F
authors.initials: CF
authors.lastname: Russell
authors.forename: W R
authors.initials: WR
authors.lastname: Ferguson
authors.forename: J D
authors.initials: JD
authors.lastname: Laird
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D011300:Preoperative Care; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D013670:Sodium Pertechnetate Tc 99m
chemical_list: D013670:Sodium Pertechnetate Tc 99m