Sestamibi scan-directed, minimally invasive video-assisted parathyroidectomy: an effective treatment for solitary parathyroid adenoma

• Published in: Irish journal of medical science Vol. 176; no. 4; pp. 283 - 287
• Main Authors: Murphy, A D, Andrews, E J, Ishtiaq, A, Jawad, A, McCarthy, P A, O'Keeffe, D, Dunne, F, Quill, D S
• Format: Journal Article
• Language: English
• Published: Ireland 01.12.2007
• Subjects: Adenoma - diagnostic imaging; Adenoma - surgery; Aged; Cohort Studies; Female; Humans; Hyperparathyroidism - diagnosis; Hyperparathyroidism - etiology; Male; Middle Aged; Minimally Invasive Surgical Procedures - methods; Neoplasm Invasiveness - pathology; Parathyroid Neoplasms - diagnostic imaging; Parathyroid Neoplasms - surgery; Parathyroidectomy - methods; Predictive Value of Tests; Preoperative Care; Probability; Risk Assessment; Sensitivity and Specificity; Statistics, Nonparametric; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Video-Assisted Surgery - methods
• ISSN: 0021-1265; 1863-4362
• DOI: 10.1007/s11845-007-0075-1

Solitary adenomas have been shown to be responsible for almost 90% of cases of primary hyperparathyroidism. The purpose of this study was to determine the utility of sestamibi scanning pre-operatively to guide minimally invasive video-assisted (MIVA) parathyroidectomy. We reviewed 40 patients who underwent parathyroidectomy between 2003 and 2004. All patients underwent a pre-operative sestamibi scan. Thirty-three (82%) patients had a localized solitary adenoma on sestamibi scan. Of these patients 29 underwent attempted MIVA parathyroidectomy. MIVA parathyroidectomy was successful in 22 patients. When pre-operative sestamibi scanning was correlated with pathological diagnosis it was shown to have a sensitivity of 82% and positive predictive value of 94%. Pre-operative sestamibi scan localization of a parathyroid adenoma offers a 94% positive predictive value for adenoma location. This facilitates MIVA parathyroidectomy to be used effectively to treat primary hyperparathyroidism in the majority of patients.