title: Limitations of technetium 99m sestamibi scintigraphic localization for primary hyperparathyroidism associated with multiglandular disease.
abstract: Successful surgical treatment of primary hyperparathyroidism requires the localization and excision of the parathyroid tissue responsible for excessive parathyroid hormone secretion while ensuring that the patient will have sufficient endogenous parathyroid hormone production to maintain eucalcemia. In selecting patients with primary hyperparathyroidism for unilateral parathyroidectomy the surgeon should be able to diagnose multiglandular disease either preoperatively or intraoperatively. We performed a retrospective review of 123 patients who underwent surgical treatment for primary hyperparathyroidism to determine the potential feasibility of selecting patients for minimally invasive surgery based on preoperative imaging studies. All patients were studied preoperatively with 99m technetium-sestamibi scintigraphy. High-resolution ultrasonography was performed in 119 of these patients. All patients except one underwent bilateral cervical exploration. A patient with an intrathoracic adenoma was successfully diagnosed by scintigraphy thereby allowing treatment by a limited thoracotomy. One hundred eight patients had solitary adenomas and 15 had multiglandular disease. In none of the patients with bilateral multiglandular disease were all abnormal glands localized preoperatively. Patients in our study with primary hyperparathyroidism and multiglandular disease were underdiagnosed by preoperative imaging. A minimally invasive approach based solely on preoperative imaging studies may result in treatment failure in patients with multiglandular involvement.
authors.affiliation: Division of Oncology, Department of Surgery, New York University School of Medicine, New York, New York 10016, USA.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Katz
authors.forename: Grace J
authors.initials: GJ
authors.lastname: Wang
authors.forename: Elissa L
authors.initials: EL
authors.lastname: Kramer
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Roses
mesh_terms: D000236:Adenoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D015982:Bias; D002118:Calcium / Q000097:blood; D002828:Choristoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000209:etiology*; D007669:Kidney Calculi / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands; D010282:Parathyroid Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods* / Q000592:standards; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D013896:Thoracic Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D013906:Thoracoscopy; D013908:Thoracotomy
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D002118:Calcium