Incidence and location of ectopic abnormal parathyroid glands.
BACKGROUND
Ectopic parathyroid glands are a cause for failed parathyroid exploration.


METHODS
Patients with hyperparathyroidism and ectopic parathyroid glands were identified from a parathyroid database. Laboratory data, gland weights, and surgical outcomes were obtained. The locations of the ectopic glands were correlated with results of technetium-99m-sestamibi imaging.


RESULTS
Of 231 patients operated on for hyperparathyroidism, 37 (16%) had ectopic parathyroid glands. Ectopic inferior glands (N = 23 [62%]) were intrathymic, n = 7 (30%); anterosuperior mediastinal, n = 5 (22%); intrathyroidal, n = 5 (22%); within the thyrothymic ligament, n = 4 (17%); and submandibular, n = 2 (9%). Ectopic superior glands (N = 14 [38%]) were in the tracheoesophageal groove, n = 6 (43%); retroesophageal, n = 3 (22%); posterosuperior mediastinal, n = 2 (14%); intrathyroidal, n = 1 (7%); in the carotid sheath, n = 1 (7%); and paraesophageal, n = 1 (7%). Sestamibi scans were true-positive in 81%, identifying 13 of 16 retrosternal glands, and false-negative in 19%.


CONCLUSIONS
A 16% incidence of ectopic parathyroid glands and a 100% positive predictive value of sestamibi scintigraphy underscore the importance of sestamibi imaging in patients with primary hyperparathyroidism.
Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, 2500 Metrohealth Drive, Cleveland, OH 44109, USA.
Roy
R
Phitayakorn
Christopher R
CR
McHenry
D002828:Choristoma / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000601:surgery; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands; D011300:Preoperative Care; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D017256:Technetium Tc 99m Sestamibi; D014481:United States / Q000453:epidemiology
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi