Can thallium-pertechnetate subtraction scanning play a role in the preoperative imaging for minimally invasive parathyroidectomy?
OBJECTIVE
Preoperative Tc-99m sestamibi scanning can identify candidates for minimally invasive parathyroid surgery. However, a significant number of patients with single gland disease have negative scans and are not considered for the minimally invasive procedure.


METHODS
To determine if T1-201/Tc-99m sodium pertechnetate subtraction scanning (TPSS) is a viable alternative imaging technique for patients with primary hyperparathyroidism (1 degrees HPTH), we reviewed our experience. The outcomes of 100 consecutive patients with 1 degrees HPTH who underwent preoperative TPSS and parathyroid exploration between 1995 and 2000 at our institution were retrospectively reviewed.


RESULTS
The mean preoperative calcium and parathyroid hormone levels were 10.8 mg/dL and 220 pg/mL, respectively. The overall cure rate was 96%. Single gland disease was present in 88%. Of the 100 patients studied, 15 underwent both a Tc-99m sestamibi scan and TPSS, whereas the other 85 had only the TPSS.


CONCLUSIONS
The sensitivity and positive predictive value of the TPSS were 73.3% and 90.4%, respectively. In the patients undergoing both TPSS and Tc-99m sestamibi scans, the results concurred in 60%. However, in 20% of the remaining patients, TPSS correctly localized the abnormal parathyroid(s) when Tc-99m sestamibi failed. TPSS has a comparable sensitivity and positive predictive value to Tc-99m sestamibi scanning. In patients with a negative Tc-99m sestamibi scan, TPSS can provide additional localizing information. As a result of the high positive predictive value of TPSS, a single parathyroid gland localized by TPSS alone can then be approached by minimally invasive parathyroidectomy.
Sippel
Rebecca S
RS
Department of Surgery, University of Wisconsin Medical School, Madison, Wisconsin 53792, USA.
Bianco
Jesus
J
Wilson
Michael
M
Perlman
Scott
S
Ozgül
Omer
O
Mack
Eberhard
E
Starling
James
J
Chen
Herbert
H
D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D016105:Parathyroidectomy; D018579:Patient Selection; D011300:Preoperative Care; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012680:Sensitivity and Specificity; D013670:Sodium Pertechnetate Tc 99m; D013382:Subtraction Technique; D013793:Thallium; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; C027549:thallium chloride; D013670:Sodium Pertechnetate Tc 99m; D013793:Thallium