title: Are additional localization studies and referral indicated for patients with primary hyperparathyroidism who have negative sestamibi scan results?
abstract: OBJECTIVE
  Additional imaging studies are useful to select patients who are candidates for minimally invasive parathyroidectomy, and referral is not indicated when results from a preoperative sestamibi scan are negative.
  
  
  METHODS
  Prospective analysis of 492 operations for primary hyperparathyroidism from May 2005 to May 2007 at a tertiary care center.
  
  
  METHODS
  Accuracy of imaging studies, pathologic findings, and biochemical cure.
  
  
  RESULTS
  Among the patients, 96% were cured. Of the sestamibi scan results, 91% were positive and 82% were true-positive. Ultrasonography results were positive in 51% of patients with negative sestamibi scan results, and 43% were true-positive. Patients with positive sestamibi scan results compared with those with negative sestamibi scan results had a higher rate of single-gland disease (87% vs 63%, respectively) and lower rates of double adenoma (6% vs 22%, respectively) and asymmetric hyperplasia (7% vs 15%, respectively) (P<.001). In patients with positive sestamibi scan results compared with those with negative sestamibi scan results, there was no significant difference in the rate of ectopic parathyroid glands (18% vs 12%, respectively) but there was a significant difference in cure rate (97% vs 89%, respectively) (P=.008).
  
  
  CONCLUSIONS
  Additional imaging with neck ultrasonography is helpful for selecting minimally invasive parathyroidectomy in most patients with primary hyperparathyroidism who have negative sestamibi scan results. Referral for parathyroidectomy may be considered in patients with negative sestamibi scan results because these results are associated with multigland disease and lower cure rates.
authors.affiliation: Department of Surgery, Feinberg School of Medicine, Northwestern University, 676 N St Clair St, Ste 650, Chicago, IL 60611, USA. delaraj@nmh.org
authors.forename: Dina M
authors.initials: DM
authors.lastname: Elaraj
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Sippel
authors.forename: Sheila
authors.initials: S
authors.lastname: Lindsay
authors.forename: Ileana
authors.initials: I
authors.lastname: Sansano
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
authors.forename: Orlo H
authors.initials: OH
authors.lastname: Clark
authors.forename: Electron
authors.initials: E
authors.lastname: Kebebew
mesh_terms: D000328:Adult; D000368:Aged; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016343:Monitoring, Intraoperative / Q000379:methods; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000601:surgery; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000379:methods*; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017256:Technetium Tc 99m Sestamibi; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
chemical_list: D010281:Parathyroid Hormone; D017256:Technetium Tc 99m Sestamibi