The false-positive parathyroid sestamibi: a real or perceived problem and a case for radioguided parathyroidectomy.
OBJECTIVE
To demonstrate that the positive parathyroid sestamibi scan, if correctly interpreted and applied, truly represents a parathyroid adenoma, never a "false-positive" scan.


BACKGROUND
Although the sestamibi scan is widely ordered preoperatively to locate parathyroid adenomas, concern about a false-positive scan often causes surgeons to distrust the results. Tissues such as thyroid adenomas and lymph nodes have been blamed for false-positive studies, but the radioactivity of these presumed false-positive tissues has never been measured.


METHODS
Over an 1 8-month period, 17 patients were referred for persistent primary hyperparathyroidism after undergoing at least one neck exploration. All patients had a sestamibi scan prior to their initial operation that was interpreted as clearly positive and then, during or after an unsuccessful operation, deemed false-positive by the surgeon. At the authors' institution, all patients underwent repeat sestamibi scintigraphy and were taken to the operating room while radioactive for a minimally invasive radioguided parathyroidectomy (MIRP).


RESULTS
The authors' sestamibi scans demonstrated the same single focus of radioactivity displayed on the outside scans, clearly positive. During MIRP, an adenoma was successfully located and removed in all patients, with confirmation of the diagnosis by quantitative differential radioactivity and subsequent histologic examination. Removal of the radioactive tissue cured all patients.


CONCLUSIONS
Intraoperative nuclear mapping permitted identification and removal of parathyroid adenomas in all patients with positive sestamibi scans that had previously been labelled false-positive, indicating that each patient would have been cured during their previous operation if radioguided techniques were used. Surgeons should be extremely cautious in deciding intraoperatively that a positive sestamibi scan is a false-positive scan.
Norman
J G
JG
Department of Surgery, University of South Florida, Tampa 33601, USA.
Jaffray
C E
CE
Chheda
H
H
D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery*; D005189:False Positive Reactions; D015902:Gamma Cameras; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures; D016343:Monitoring, Intraoperative; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D011877:Radionuclide Imaging; D012086:Reoperation; D017256:Technetium Tc 99m Sestamibi; D016896:Treatment Outcome
D017256:Technetium Tc 99m Sestamibi