Original CommunicationsProspective evaluation of delayed technetium-99m sestamibi SPECT scintigraphy for preoperative localization of primary hyperparathyroidism*
Section snippets
Patient population
From 1994 to 2000, 338 consecutive patients with biochemically confirmed 10HPTH underwent preoperative Tc-99m sestamibi parathyroid SPECT scintigraphy (sestamibi-SPECT) and were explored by 1 endocrine surgeon. There were 287 patients (85%) who had not undergone cervical exploration, whereas 51 (15%) patients had undergone reoperative cervical exploration. Biochemical confirmation of 1°HPTH was obtained in every patient by demonstrating increased or inappropriate serum calcium concentrations,
Surgical results
There were 233 women and 105 men, ranging in age from 13 to 88 years, with a mean of 58.4 ± 13.5 years. In these 338 consecutive patients, there were 400 surgically excised abnormal parathyroid glands. There were 287 unexplored patients, of which 139 underwent minimally invasive parathyroidectomy and 148 underwent conventional exploration. Two hundred ninety-nine patients had solitary parathyroid adenomas, 23 had double parathyroid adenomas, and 14 patients with multiglandular hyperplasia had a
Discussion
Many investigators have documented the efficiency of Tc-99m sestamibi scans in localizing parathyroid adenomas. Reported sensitivities for the localization of parathyroid adenomas with dual phase planar Tc-99m sestamibi scintigraphy vary between 43% to 91%.20 By this method, areas of increased activity on early images that persist on delayed images (2-3 hours after injection) are interpreted to represent abnormal parathyroid glands. In contrast, activity in the normal thyroid gland washes out
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Reprint requests: Robert Udelsman, MD, MBA, Chairman, Department of Surgery, Yale University School of Medicine, 330 Cedar St, PO Box 208062, New Haven, CT 06520-8062.