Usefulness of preoperative Tc-mibi parathyroid scintigraphy in secondary hyperparathyroidism.
OBJECTIVE
The usefulness of Tc-mibi parathyroid scintigraphy (Tc-PS) in planning parathyroidectomy for secondary hyperparathyroidism is not well known. The aim of this study was to review our experience with Tc-PS concerning: (1) the identification of hyperplastic glands, (2) detection of major ectopias and (3) prevention of recurrences.


METHODS
Thirty-three consecutive patients undergoing first-time subtotal parathyroidectomy for renal hyperparathyroidism had a dual-phase planar Tc-PS performed, and glands were classified as detected, weak, or not detected. The number and position of visualized glands were determined. Parathyroid weight, histology, and their relationship to Tc-PS were recorded after surgery.


RESULTS
Of 132 potential glands, 48 (35%) were localized on the Tc-PS and 128 (96.9%) were identified intraoperatively. Tc-PS positive/weak glands were heavier than nonlocalized glands. Tc-PS contributed to successful surgery in four patients with a single difficult gland each (three retrieved from the neck and one--fifth gland--requiring mediastinotomy). There was one persistence (3%) because of a missed fourth undescended inferior parathyroid gland. Two recurrences 2 years after surgery were due to a fifth thoracic gland not shown in the preoperative Tc-PS.


CONCLUSIONS
Preoperative Tc-PS helped in the intraoperative identification of moderate or major ectopias in 4/33 patients but was not useful to prevent recurrences from highly ectopic glands not visualized before first-time surgery.
de la Rosa
Alberto
A
Department of Surgery, Endocrine Surgery Unit, Hospital del Mar, Paseo Marítimo 25-29, 08003 Barcelona, Spain.
Jimeno
Jaime
J
Membrilla
Estela
E
Sancho
Joan J
JJ
Pereira
José A
JA
Sitges-Serra
Antonio
A
D000328:Adult; D000368:Aged; D002828:Choristoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000150:complications; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging* / Q000601:surgery*; D006965:Hyperplasia; D008297:Male; D008477:Mediastinal Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D008481:Mediastinoscopy; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging* / Q000601:surgery; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000473:pathology; D016105:Parathyroidectomy; D011877:Radionuclide Imaging; D055502:Secondary Prevention; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi
D017256:Technetium Tc 99m Sestamibi