title: Sestamibi scan-directed, minimally invasive video-assisted parathyroidectomy: an effective treatment for solitary parathyroid adenoma.
abstract: BACKGROUND
  Solitary adenomas have been shown to be responsible for almost 90% of cases of primary hyperparathyroidism.
  
  
  OBJECTIVE
  The purpose of this study was to determine the utility of sestamibi scanning pre-operatively to guide minimally invasive video-assisted (MIVA) parathyroidectomy.
  
  
  METHODS
  We reviewed 40 patients who underwent parathyroidectomy between 2003 and 2004. All patients underwent a pre-operative sestamibi scan.
  
  
  RESULTS
  Thirty-three (82%) patients had a localized solitary adenoma on sestamibi scan. Of these patients 29 underwent attempted MIVA parathyroidectomy. MIVA parathyroidectomy was successful in 22 patients. When pre-operative sestamibi scanning was correlated with pathological diagnosis it was shown to have a sensitivity of 82% and positive predictive value of 94%.
  
  
  CONCLUSIONS
  Pre-operative sestamibi scan localization of a parathyroid adenoma offers a 94% positive predictive value for adenoma location. This facilitates MIVA parathyroidectomy to be used effectively to treat primary hyperparathyroidism in the majority of patients.
authors.affiliation: Department of Surgery, University College Hospital, Galway, Ireland. adrian.murphy@mac.com
authors.forename: A D
authors.initials: AD
authors.lastname: Murphy
authors.forename: E J
authors.initials: EJ
authors.lastname: Andrews
authors.forename: A
authors.initials: A
authors.lastname: Ishtiaq
authors.forename: A
authors.initials: A
authors.lastname: Jawad
authors.forename: P A
authors.initials: PA
authors.lastname: McCarthy
authors.forename: D
authors.initials: D
authors.lastname: O'Keeffe
authors.forename: F
authors.initials: F
authors.lastname: Dunne
authors.forename: D S
authors.initials: DS
authors.lastname: Quill
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000379:methods*
chemical_list: D017256:Technetium Tc 99m Sestamibi