title: Minimally invasive/focused parathyroidectomy in patients with negative sestamibi scan results.
abstract: OBJECTIVE
  To examine the feasibility of minimally invasive/focused parathyroidectomy in patients with primary hyperparathyroidism and negative results on preoperative sestamibi scanning.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Hospital.
  
  
  METHODS
  A total of 452 patients with primary hyperparathyroidism underwent parathyroidectomy between January 2005 and December 2009.
  
  
  METHODS
  Preoperative sestamibi scans were reviewed, and their influence on the surgical outcome was examined. Records of the intraoperative and postoperative findings were also reviewed.
  
  
  RESULTS
  Seventy-seven patients (17.0%) were found to have negative results on preoperative sestamibi scans, and these patients formed our cohort study group. In this group, neck ultrasonography performed as an adjunct was able to preoperatively localize an area that was suggestive of a single adenoma in 61 patients (79.2%), 53 of whom were confirmed to have a single adenoma intraoperatively (sensitivity, 80.3%; specificity, 27.3%; positive predictive value, 86.9%; and negative predictive value, 18.8%). In total, 66 of 77 patients (85.7%) were confirmed to have a single adenoma at the time of surgery.
  
  
  CONCLUSIONS
  Negative results on sestamibi scans should not be used as exclusion criteria for minimally invasive/focused parathyroidectomy in patients with primary hyperparathyroidism. In our study, 66 patients with negative results on preoperative scans were found to have a single adenoma and were surgically cured by minimally invasive/focused parathyroidectomy.
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
authors.forename: Emad
authors.initials: E
authors.lastname: Kandil
authors.forename: Ahmed Jan
authors.initials: AJ
authors.lastname: Malazai
authors.forename: Saud
authors.initials: S
authors.lastname: Alrasheedi
authors.forename: Ralph P
authors.initials: RP
authors.lastname: Tufano
mesh_terms: D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016105:Parathyroidectomy / Q000379:methods*; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi