title: Improved localization of sestamibi imaging at high-volume centers.
abstract: OBJECTIVE
  Sestamibi imaging can provide critical information regarding the location of suspected parathyroid adenomas. However, this modality can be challenging to perform and interpret reliably. The impact of experience on the localizing efficacy of sestamibi scanning was assessed.
  
  
  METHODS
  Prospective analysis of a consecutive series of patients undergoing parathyroidectomy was undertaken after institutional review board approval was obtained.
  
  
  METHODS
  Patients undergoing parathyroid surgery from October 2003 through June 2011 were considered. Inclusion criteria represented primary surgery for primary hyperparathyroidism, in which a single adenoma was excised and cure obtained. Sestamibi scan results, performed at our institution and at outside imaging centers, were compared to intraoperative findings.
  
  
  RESULTS
  There were 389 parathyroidectomies performed; 188 patients met inclusion criteria. Fifty-four patients had sestamibi scans performed at outside institutions; 36 (67%) were localizing and 18 (33%) were nonlocalizing. Among localizing studies, half identified the correct quadrant and half recognized the correct side. At our institution, 147 patients underwent sestamibi imaging; 121 (82%) localized and 26 (18%) did not. Among localizing studies, the correct quadrant was reported in 64% and the correct side in 36%. Of the 147 scans performed at our institution, 13 represented repeat scans of patients with nonlocalizing outside scans. All 13 of these localized; six identified the correct quadrant and seven the side of the adenoma.
  
  
  CONCLUSIONS
  A high volume of experience may improve the yield of sestamibi imaging. Repeating this study at a high-volume center when it was nonlocalizing elsewhere may provide useful additional information.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Georgia Health Sciences University, Augusta, Georgia 30912-4060, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Singer
authors.forename: Darko
authors.initials: D
authors.lastname: Pucar
authors.forename: Manoj
authors.initials: M
authors.lastname: Mathew
authors.forename: David J
authors.initials: DJ
authors.lastname: Terris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods*; D011446:Prospective Studies; D011877:Radionuclide Imaging; D017256:Technetium Tc 99m Sestamibi; D055815:Young Adult
chemical_list: D017256:Technetium Tc 99m Sestamibi