99MTc-sestamibi as sole technique in selection of primary hyperparathyroidism patients for unilateral neck exploration.
BACKGROUND
Unilateral neck exploration (UNE) is becoming the procedure of choice for treatment of primary hyperparathyroidism (PHPT). The aim of this study was to evaluate the role of (99m)Tc-sestamibi (MIBI) parathyroid scintigraphy as the sole technique in selecting patients for UNE.


METHODS
We selected 136 consecutive PHPT patients who had only 1 solitary uptake at a MIBI were for UNE. The technique was a single dual-phase using MIBI and a subtraction technique with (99m)Tc-pertechnetate. Imaging data were correlated with surgical results.


RESULTS
In 3 cases, the sestamibi scan was falsely positive, 1 had a contralateral location relative to the uptake, and 2 had multiglandular hyperplasia. Overall, the positive predictive value (PPV) of MIBI for detecting a solitary parathyroid adenoma in patients with 1 solitary uptake was 97.8. Sixteen patients (12%) had evidence of multinodular goiter. Overall, the PPV of MIBI was 98.4% (2 false positive among 120 cases) in patients with no multinodular thyroid disease (MNG) and 93.7% (1 false negative among 16 cases) in patients with MNG. The mean duration of the surgical procedure was 34.17 minutes. Mean hospitalization was 0.6 days. Conversion to bilateral neck exploration was performed in 5 patients. After a period of follow-up of 40 months (range, 6-72 months), the cure rate was 98%.


CONCLUSIONS
Patients with PHPT and unequivocally positive preoperative (99m)Tc-sestamibi can safely be managed with UNE without additional localizing techniques.
Moure
Dolores
D
Department of Endocrinology, Hospital de la Princesa, Universidad Autónoma, Madrid, Spain. lolimoure@yahoo.es
Larrañaga
Eduardo
E
Domínguez-Gadea
Luis
L
Luque-Ramírez
Manuel
M
Nattero
Lia
L
Gómez-Pan
Antonio
A
Marazuela
Monica
M
D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D016105:Parathyroidectomy; D011300:Preoperative Care; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi