title: Utility of preoperative radionuclide scanning for primary hyperparathyroidism.
abstract: This study retrospectively reviews 60 cases of primary hyperparathyroidism, 21 of whom underwent technetium 99 sestamibi scanning and 10 of whom underwent thallium 201/technetium 99 pertechnetate scanning preoperatively. The sestamibi and thallium scans demonstrated an 89.5% and a 62.5% sensitivity rate for adenoma, respectively. Neither scan demonstrated hyperplastic glands well. Although the scans localized adenomatous glands to the correct side well, the ability to localize them more discretely was 68.4% and 62.5%, respectively. In cases of solitary adenoma the effect of an accurate preoperative scan on operative time for bilateral exploration was not significant, whereas the experience of the attending surgeon was significant. Also, the cost of the scans at our institution was greater than the cost of the time saved in performing even unilateral neck exploration. Thus preoperative radionuclide scanning is not cost-effective for the initial exploration of patients with primary hyperparathyroidism and is insufficiently sensitive to make routine unilateral neck exploration for adenoma consistently effective.
authors.affiliation: Otolaryngology-Head and Neck Surgery Service, Walter Reed Army Medical Center, Washington, D.C. 20307-5001, U.S.A.
authors.forename: C K
authors.initials: CK
authors.lastname: Sinha
authors.forename: R
authors.initials: R
authors.lastname: Hamaker
authors.forename: R C
authors.initials: RC
authors.lastname: Hamaker
authors.forename: S B
authors.initials: SB
authors.lastname: Freeman
authors.forename: R W
authors.initials: RW
authors.lastname: Borrowdale
authors.forename: T C
authors.initials: TC
authors.lastname: Huntley
mesh_terms: D000236:Adenoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000191:economics; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013670:Sodium Pertechnetate Tc 99m / Q000191:economics; D017256:Technetium Tc 99m Sestamibi / Q000191:economics; D013794:Thallium Radioisotopes / Q000191:economics
chemical_list: D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D017256:Technetium Tc 99m Sestamibi; D013670:Sodium Pertechnetate Tc 99m