title: Role of microvascular density in nonlocalizing parathyroid sestamibi scans.
abstract: OBJECTIVE
  Sestamibi scans for localization of abnormal parathyroid glands in patients with hyperparathyroidism are widely used at many institutions. Minimally invasive parathyroid surgery demands accurate preoperative localization imaging; however, nonlocalizing sestamibi scans occur in 15% of patients with primary hyperparathyroidism. It remains unknown why some sestamibi scans fail to localize. We hypothesize that an increase in microvascular density (MVD) within an adenoma will result in rapid tracer washout and a subsequent nonlocalizing scan. This study investigates the role of MVD in sestamibi localization.
  
  
  METHODS
  Retrospective chart review with immunohistochemical staining and data analysis.
  
  
  METHODS
  Medical records of 83 patients who had a sestamibi scan for evaluation of primary hyperparathyroidism and underwent initial parathyroidectomy from 2000 to 2002 were retrospectively reviewed. Patients' age, sex, preoperative imaging results, operative procedure, gland weight, and histologic findings were collected. Immunohistochemistry was performed to assess MVD.
  
  
  RESULTS
  Of the 75 preoperative sestamibi scans used, 51 patients had a localizing scan, and 24 were nonlocalizing. Localizing sestamibi scans for primary hyperparathyroidism demonstrated a sensitivity of 94% and specificity of 85%. By identifying multiglandular hyperplasia, nonlocalizing sestamibi scans produced a sensitivity of 83%. The localizing group had a greater percentage of solitary adenomas (94%) compared with the nonlocalizing group (15.6%) (P < .001). The mean gland weight for the nonlocalizing group was less than 398 g compared with the localizing groupweight of 1,113 g (P < .001). The mean MVD for localizing scan group was 229 vessels per high-power field,and the mean for the nonlocalizing scans was 213 vessels per high-power field (P = .2).
  
  
  CONCLUSIONS
  MVD does not predict whether sestamibi scans are localizing or nonlocalizing.
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL 35294-0012, USA. Glenn.Peters@ccc.uab.edu
authors.forename: Glenn
authors.initials: G
authors.lastname: Peters
authors.forename: Brian
authors.initials: B
authors.lastname: Kulbersh
authors.forename: Belinda
authors.initials: B
authors.lastname: Mantle
authors.forename: Walter
authors.initials: W
authors.lastname: Bell
authors.forename: William
authors.initials: W
authors.lastname: Grizzle
authors.forename: Eben
authors.initials: E
authors.lastname: Rosenthal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D007150:Immunohistochemistry; D008297:Male; D008833:Microcirculation / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010280:Parathyroid Glands / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D016105:Parathyroidectomy; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017256:Technetium Tc 99m Sestamibi
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi