RT Journal
A1 Stephen AE, Roth SI, Fardo DW, et al
T1 PRedictors of an accurate preoperative sestamibi scan for single-gland parathyroid adenomas
JF Archives of Surgery
JO Archives of Surgery
YR 2007
FD April 1
VO 142
IS 4
SP 381
OP 386
DO 10.1001/archsurg.142.4.381
UL http://dx.doi.org/10.1001/archsurg.142.4.381
AB Objective 
    To investigate why some patients with single parathyroid adenomas have negative preoperative sestamibi scans.Design 
    Retrospective review.Setting 
    Tertiary care center.Patients 
    Twenty-one patients with false-negative (FN) scans were compared with 22 patients with true-positive (TP) scans. All patients had single parathyroid adenomas.Interventions 
    Neck exploration and removal of parathyroid adenomas.Main Outcome Measures 
    Age; sex; preoperative serum calcium and parathyroid hormone levels; gland weight; location; and pathologic features.Results 
    There was no significant difference in age or preoperative serum calcium or parathyroid hormone levels. Gland weight was greater in the TP group compared with the FN group (mean ± SD, 1336 ± 1603 mg vs 475 ± 365 mg;  = .04); 13 (62%) of the 21 glands in the FN group were located in the upper position, compared with 6 (27%) of the 22 glands in the TP group ( = .03). Ten of the 22 glands in the TP group consisted predominantly of oxyphil cells, compared with 2 of the 21 glands in the FN group ( = .02). A multivariate logistic regression model yielded the following factors that predicted an accurate scan: higher percentage of oxyphil cells ( = .03), heavier gland ( = .03), female sex ( = .04), and gland location in the lower position ( = .04).Conclusions 
    Smaller-volume parathyroid adenomas and those in the upper position are less likely to be localized with sestamibi scans. A TP scan correlates with oxyphil cell predominance, supporting a role for the mitochondrial-rich cell in sestamibi uptake and retention.