Methylene blue and sestamibi: complementary tools for localizing parathyroids.
OBJECTIVE
To determine the value and correlation between sestamibi scan and methylene blue staining for localization of parathyroid glands in patients with primary hyperparathyroidism.


METHODS
Nonrandomized convenience sample, followed prospectively.


METHODS
Twenty-three consecutive patients underwent 24 operations for primary hyperparathyroidism. All patients underwent preoperative technetium 99m-sestamibi planar scintigraphy, preoperative administration of 7.5 mg/kg methylene blue initiated within 60 minutes of surgical incision, and surgical neck exploration supervised by a single surgeon.


RESULTS
All patients were cured of hypercalcemia. Sensitivity for sestamibi and for methylene blue staining was 76% and 79%, respectively. Specificity for sestamibi and for methylene blue was 98% and 93%, respectively. Agreement between sestamibi and methylene blue was 96%.


CONCLUSIONS
Sestamibi scanning and methylene blue staining are useful, complementary localizing tools for patients undergoing surgery for primary hyperparathyroidism. When used together, these studies decrease operative time, justify unilateral exploration in patients with parathyroid adenoma, and increase the ease of identification of hyperplastic parathyroid glands.
Orloff
L A
LA
Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego Medical Center, San Diego, California 92103-8891, USA. lorloff@ucsd.edu
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007430:Intraoperative Care; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000473:pathology*; D011300:Preoperative Care; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013194:Staining and Labeling; D017256:Technetium Tc 99m Sestamibi
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D008751:Methylene Blue