Sestamibi scan-directed, minimally invasive video-assisted parathyroidectomy: an effective treatment for solitary parathyroid adenoma.
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.
Murphy
A D
AD
Department of Surgery, University College Hospital, Galway, Ireland. adrian.murphy@mac.com
Andrews
E J
EJ
Ishtiaq
A
A
Jawad
A
A
McCarthy
P A
PA
O'Keeffe
D
D
Dunne
F
F
Quill
D S
DS
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*
D017256:Technetium Tc 99m Sestamibi