Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism.
OBJECTIVE
To evaluate the usefulness of the combination of Tc-sestamibi/Tc-pertechnetate subtraction scintigraphy (SS) and high-resolution neck ultrasonography (US) in patients with primary hyperparathyroidism (pHPT) undergoing parathyroidectomy.


METHODS
Ninety-one patients with proved pHPT were studied, excluding patients with persistent or recurrent disease. There were 65 (71.4%) women and 26 (28.6%) men, with a median age of 59 years (range 18-78 years). All patients underwent both SS and US prior to surgery, and the results were compared with operative and histological findings. The intraoperative quick-parathyroid hormone assay was available for 52 (57.1%) patients. When multiglandular disease was found, both SS and US were considered truly positive only when at least two enlarged parathyroid (PT) glands had been localized.


RESULTS
Eighty-three (91.2%) solitary PT adenomas and three (3.3%) carcinomas were found. Moreover, two (2.2%) patients had a double adenoma and three (3.3%) patients had diffuse PT hyperplasia. The overall sensitivity of combined SS+US was 94.5% (86.8% and 80.4% for SS and US respectively). There was a significant (P<0.05, Student's t-test) difference in size between the PT glands correctly identified and undetected by SS, whereas the site of the removed PT tumors significantly (P<0.05, Fisher exact test) influenced only the US sensitivity.


CONCLUSIONS
When the preoperative localization of the PT glands is chosen, the combination of SS and US represents a reliable noninvasive localization technique and should be considered for use in each patient with pHPT undergoing surgery.
Lumachi
F
F
Endocrine Surgery Unit, Department of Surgical and Gastroenterology Sciences, University of Padua, School of Medicine, via Giustiniani 2, 35128 Padova, Italy. lumachi@ux1.unipd.it
Zucchetta
P
P
Marzola
M C
MC
Boccagni
P
P
Angelini
F
F
Bui
F
F
D'Amico
D F
DF
Favia
G
G
D000236:Adenoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012008:Recurrence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D014463:Ultrasonography
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi