title: Predictors of an accurate preoperative sestamibi scan for single-gland parathyroid adenomas.
abstract: OBJECTIVE
  To investigate why some patients with single parathyroid adenomas have negative preoperative sestamibi scans.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Twenty-one patients with false-negative (FN) scans were compared with 22 patients with true-positive (TP) scans. All patients had single parathyroid adenomas.
  
  
  METHODS
  Neck exploration and removal of parathyroid adenomas.
  
  
  METHODS
  Age; sex; preoperative serum calcium and parathyroid hormone levels; gland weight; location; and pathologic features.
  
  
  RESULTS
  There was no significant difference in age or preoperative serum calcium or parathyroid hormone levels. Gland weight was greater in the TP group compared with the FN group (mean +/- SD, 1336 +/- 1603 mg vs 475 +/- 365 mg; P = .04); 13 (62%) of the 21 glands in the FN group were located in the upper position, compared with 6 (27%) of the 22 glands in the TP group (P = .03). Ten of the 22 glands in the TP group consisted predominantly of oxyphil cells, compared with 2 of the 21 glands in the FN group (P = .02). A multivariate logistic regression model yielded the following factors that predicted an accurate scan: higher percentage of oxyphil cells (P = .03), heavier gland (P = .03), female sex (P = .04), and gland location in the lower position (P = .04).
  
  
  CONCLUSIONS
  Smaller-volume parathyroid adenomas and those in the upper position are less likely to be localized with sestamibi scans. A TP scan correlates with oxyphil cell predominance, supporting a role for the mitochondrial-rich cell in sestamibi uptake and retention.
authors: Department of Surgical Oncology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114, USA. astephen@partners.org
authors: Antonia E
authors: AE
authors: Stephen
authors: Sanford I
authors: SI
authors: Roth
authors: David W
authors: DW
authors: Fardo
authors: Dianne M
authors: DM
authors: Finkelstein
authors: Gregory W
authors: GW
authors: Randolph
authors: Randall D
authors: RD
authors: Gaz
authors: Richard A
authors: RA
authors: Hodin
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi