Minimally invasive parathyroidectomy and preoperative MIBI scans: correlation of gland weight and preoperative PTH.
BACKGROUND
Minimally invasive parathyroidectomy (MIP) has become increasingly popular for the treatment of patients with primary hyperparathyroidism (pHPT), and the specific techniques used vary from surgeon to surgeon. This strategy depends on preoperative localization tests, of which the MIBI scan is the most commonly used. This study details one surgeon's MIP experience and examines factors that correlate with the results of sestamibi (MIBI) scans.


METHODS
A retrospective review of parathyroidectomies performed between 1996-2006 was performed to create a database including laboratory and imaging results, symptoms, length of stay, and complications. MIBI scans were classified as correct when they showed one area of uptake at the site of a single adenoma (SA) found at exploration. Correlation between patient factors and MIBI scan results were assessed with Spearman correlation and Wilcoxon rank-sum tests.


RESULTS
Of 263 patients having parathyroidectomy for pHPT, 205 had SA, 40 double adenomas, 15 hyperplasia, and 3 negative explorations. Normocalcemia was achieved in 98% of patients at 1 year and 95% by intraoperative parathyroid hormone (PTH) criteria. Factors that were significantly correlated with MIBI scan results in SA patients were preoperative PTH (p = 0.0025) and adenoma weight (p < 0.0001). The median PTH in those with correct scans was 137 versus 101 pg/mL in those with incorrect scans, and the median adenoma weights were 920 and 280 mg, respectively.


CONCLUSIONS
The MIBI scan is a good localization test that made unilateral exploration and MIP possible in 76% of the cases. MIBI scans are more likely to be correct with higher preoperative PTH and larger adenomas.
Calva-Cerqueira
Daniel
D
Department of Surgery, University of Iowa Carver College of Medicine, IA, USA.
Smith
Brian J
BJ
Hostetler
Michelle L
ML
Lal
Geeta
G
Menda
Yusuf
Y
O'Dorisio
Thomas M
TM
Howe
James R
JR
D000236:Adenoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009929:Organ Size; D010280:Parathyroid Glands / Q000473:pathology* / Q000601:surgery; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016105:Parathyroidectomy; D011300:Preoperative Care; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi
D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi