Intraoperative sestamibi scanning in reoperative parathyroidectomy.
BACKGROUND
Reoperative neck exploration for hyperparathyroidism is often difficult even for experienced surgeons. Recent advances in preoperative and intraoperative localization techniques have improved successful resection rates. This prospective study evaluates the accuracy and clinical utility of intraoperative technetium 99m sestamibi scanning for localizing hyperfunctioning parathyroid tissue in reoperative neck explorations.


METHODS
Eleven patients underwent reoperative neck exploration for hyperparathyroidism. Two patients had 3 prior neck explorations, 1 had 2 prior neck explorations, and 8 patients had 1 prior neck operation. Preoperative studies included sestamibi scintigraphy and ultrasound in all patients, magnetic resonance imaging in 4, computed tomography scan in 3, parathyroid arteriogram in 1, and selective venous sampling in 1. All patients underwent intraoperative technetium 99m sestamibi scanning and parathyroid hormone assay.


RESULTS
Preoperative technetium 99m sestamibi scanning and ultrasound each successfully localized 7 of 11 hyperfunctioning glands (64%). Intraoperative technetium 99m sestamibi scanning correctly localized 10 of 11 hyperfunctioning glands (91%). Intraoperative parathyroid hormone assay confirmed successful excision of hyperfunctioning tissue in all 11 patients. Postoperatively, all 11 patients had low-normal or normal calcium levels.


CONCLUSIONS
Intraoperative technetium 99m sestamibi correctly localized 91% of hyperfunctioning glands compared with 64% localization for preoperative technetium 99m sestamibi and preoperative ultrasound. Intraoperative technetium 99m sestamibi scanning and parathyroid hormone monitoring are useful in reoperative neck explorations for hyperparathyroidism.
Rossi
H L
HL
Department of Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Ill. 60612, USA.
Ali
A
A
Prinz
R A
RA
D000328:Adult; D000368:Aged; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery*; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012086:Reoperation; D015203:Reproducibility of Results; D017256:Technetium Tc 99m Sestamibi
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi