title: The efficacy of sestamibi parathyroid scintigraphy for directing surgical approaches based on modified interpretation criteria.
abstract: OBJECTIVE
  With the increasing use of targeted parathyroidectomy, the accuracy of sestamibi parathyroid scintigraphy (SPS) in determining the best surgical approach has become more clinically relevant than its sensitivity for detecting all abnormal glands. The reported accuracy of SPS does not represent the true efficacy of SPS for directing targeted parathyroidectomy, because many authors reported accuracy on the basis of abnormal glands. The authors assessed the efficacy of SPS based on modified interpretation criteria to determine specifically whether SPS influences the surgeon's choice of a targeted versus a conventional approach to parathyroidectomy.
  
  
  METHODS
  The authors reviewed the SPS studies (both dual-isotope subtraction and Tc-99m sestamibi dual-phase techniques) performed in 80 patients with primary hyperparathyroidism. All patients had surgery with histologic diagnoses, intraoperative PTH assays, and clinical follow-up.
  
  
  RESULTS
  Of 75 patients with solitary adenomas, 9 SPS studies were negative, equivocal, or showed two or more foci, and 66 studies showed a solitary focus on the correct side. Of these 66 studies, 63 showed a lesion in the correct quadrant (e.g., superior or inferior) and 3 predicted the correct side only but a wrong quadrant. The positive-predictive value of SPS was 100% for correctly identifying the side of the adenoma (thus correctly directing unilateral surgery) and 95.5% for correctly identifying the quadrant of the solitary adenoma.
  
  
  CONCLUSIONS
  The positive-predictive value of SPS for directing the surgical approach (but not for detecting individual lesions) that reveals a single focus is very high based on our modified interpretation criteria.
authors.affiliation: Department of Radiology, Division of Nuclear Medicine, Mount Sinai School of Medicine of New York University, One Gustave L. Levy Place, New York, NY 10029, USA. chun.kim@mssm.edu
authors.forename: Chun K
authors.initials: CK
authors.lastname: Kim
authors.forename: Suzy
authors.initials: S
authors.lastname: Kim
authors.forename: Borys R
authors.initials: BR
authors.lastname: Krynyckyi
authors.forename: Josef
authors.initials: J
authors.lastname: Machac
authors.forename: William B
authors.initials: WB
authors.lastname: Inabnet
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D006965:Hyperplasia; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000473:pathology; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods*; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi