(99m)Technetium Sestamibi-(123)Iodine Scintigraphy Is More Accurate Than (99m)Technetium Sestamibi Alone before Surgery for Primary Hyperparathyroidism.
Objectives. Studies comparing outcome of single-(99m)Tc-methoxyisobutylisonitrile ((99m)Tc-sestamibi) and dual-tracer (99m)Tc-sestamibi scintigraphy in combination with (123)I before primary surgery of primary hyperparathyroidism (PHPT) are scarce. Methods. We compared (99m)Tc-sestamibi/(123)I and (99m)Tc-sestamibi in a single-centre retrospective series of 269 PHPT patients. The results were related to laboratory, surgical and histological findings. Results. (99m)Tc-sestamibi/(123)I and (99m)Tc-sestamibi were positive in 206 (76.6%) and 111 (41.3%) of 269 patients, respectively (P < 0.001). Accuracies for (99m)Tc-sestamibi/(123)I and (99m)Tc-sestamibi were 63.4% and 34.9%, respectively (96% CI, P < 0.001). Prevalence of multiglandular disease was 15.2%. In multiglandular disease, (99m)Tc-sestamibi/(123)I and (99m)Tc-sestamibi revealed 43.8 and 22.1% of pathological glands, respectively (P < 0.001). Cure rate was similar for patients with (191/206; 92.7%) and without (59 of 63; 93.7%) a positive (99m)Tc-sestamibi/(123)I finding. Duration of targeted surgery (one or two quadrants) was 21 and 15 minutes shorter than bilateral neck exploration, respectively (both P < 0.001). Higher serum calcium (P = 0.014) and PTH (P = 0.055) concentrations and larger tumours (P < 0.001) characterized the 206 patients with a positive preoperative scan who were cured by removal of a single adenoma. Conclusions. (99m)Tc-sestamibi/(123)I scintigraphy is more accurate than (99m)Tc-sestamibi before surgery of PHPT. However, outcome of surgery is not determined by scintigraphy alone.
Division of Endocrinology, Department of Medicine, Helsinki University Central Hospital, University of Helsinki, 00029 Helsinki, Finland.
Eeva M
EM
Ryhänen
HUS Medical Imaging Center, Department of Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital, 00029 Helsinki, Finland.
Jukka
J
Schildt
Department of Surgery, Helsinki University Central Hospital, 00029 Helsinki, Finland.
Ilkka
I
Heiskanen
Department of Surgery, Helsinki University Central Hospital, 00029 Helsinki, Finland.
Mika
M
Väisänen
HUS Medical Imaging Center, Department of Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital, 00029 Helsinki, Finland.
Aapo
A
Ahonen
Department of Biostatistics, University of Turku, 20520 Turku, Finland.
Eliisa
E
Löyttyniemi
Division of Endocrinology, Department of Medicine, Helsinki University Central Hospital, University of Helsinki, 00029 Helsinki, Finland.
Camilla
C
Schalin-Jäntti
Division of Endocrinology, Department of Medicine, Helsinki University Central Hospital, University of Helsinki, 00029 Helsinki, Finland.
Matti J
MJ
Välimäki