RT Journal
A1 Purcell GP, Dirbas FM, Jeffrey R, et al
T1 PArathyroid localization with high-resolution ultrasound and technetium tc 99m sestamibi
JF Archives of Surgery
JO Archives of Surgery
YR 1999
FD August 1
VO 134
IS 8
SP 824
OP 830
DO 10.1001/archsurg.134.8.824
UL http://dx.doi.org/10.1001/archsurg.134.8.824
AB Hypothesis 
    High-resolution ultrasound and technetium Tc 99m sestamibi scanning can be used for preoperative localization of abnormal parathyroid glands in patients with hyperparathyroidism.Design 
    Ultrasound and sestamibi scanning were performed in patients undergoing neck exploration for hyperparathyroidism. If the 2 scans agreed in identifying a single adenoma, and surgery confirmed the location of a single adenoma and an ipsilateral normal gland, a unilateral exploration was performed.Setting 
    University tertiary care center.Patients 
    Sixty-one consecutive patients undergoing surgery for hyperparathyroidism from September 1, 1994, through September 30, 1997.Interventions 
    High-resolution ultrasound was performed in 59 patients and sestamibi scanning in 58 patients; all patients underwent neck exploration by a single surgeon.Main Outcome Measures 
    The results of preoperative ultrasound and sestamibi scanning were compared with operative and histological findings.Results 
    All patients were cured of hypercalcemia. Specificity of ultrasound and sestamibi scanning was 98% and 99%, respectively; however, their sensitivity was only 57% and 54%, respectively. Both imaging modalities had lower sensitivities in the setting of multigland disease. If both imaging studies were considered as a single test, sensitivity for imaging in patients with primary hyperparathyroidism reached 78%. Our localization protocol allowed a unilateral approach in 43% of patients (23 of 53).Conclusions 
    These results confirm the value of preoperative localization in patients with hyperparathyroidism. A unilateral approach can be used with a high degree of success in cases when ultrasound and sestamibi scanning agree in the identification of a single adenoma confirmed by surgical exploration with the identification of a normal ipsilateral gland.