Value of sestamibi scans in tertiary hyperparathyroidism

• Published in: The Laryngoscope Vol. 117; no. 12; p. 2135
• Main Authors: Loftus, Kelly A, Anderson, Susan, Mulloy, Anthony L, Terris, David J
• Format: Journal Article
• Language: English
• Published: United States 01.12.2007
• Subjects: Adenoma - complications; Adenoma - diagnostic imaging; Adenoma - surgery; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Hyperparathyroidism - diagnostic imaging; Hyperparathyroidism - etiology; Hyperparathyroidism - surgery; Hyperplasia; Male; Middle Aged; Parathyroid Glands - diagnostic imaging; Parathyroid Glands - pathology; Parathyroid Glands - surgery; Parathyroid Neoplasms - complications; Parathyroid Neoplasms - diagnostic imaging; Parathyroid Neoplasms - surgery; Parathyroidectomy; Preoperative Care - methods; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Sestamibi
• ISSN: 0023-852X
• DOI: 10.1097/MLG.0b013e31813e602a

To determine the value of preoperative Tc-sestamibi scans and the incidence of ectopic glands in tertiary hyperparathyroidism. Prospective, non-randomized analysis of a consecutive cohort of surgical patients from the Medical College of Georgia Thyroid/Parathyroid Center. A consecutive series of patients with tertiary hyperparathyroidism undergoing parathyroidectomy was analyzed. Demographic data, preoperative Tc-sestamibi scintigraphy results, location of diseased glands, pre- and postoperative calcium, and parathyroid hormone levels were collected. Twenty-one patients underwent parathyroidectomy for tertiary hyperparathyroidism between March 2004 and September 2006. Of these 21 patients, 3 were re-operative cases for persistent hypercalcemia and each was found to have a single diseased gland. Of the 18 patients undergoing first time surgery, 15 had four-gland hyperplasia, 2 patients had single adenomas, and 1 patient had a double adenoma. Nine of the 21 patients (43%) had ectopic glands (2 of these patients had 2 ectopic glands each). The overall sensitivity of the preoperative Tc-sestamibi scintigraphy was 76% and was not significantly different when comparing patients with ectopic glands (78%) and those without (75%). Tc sestamibi scintigraphy has high positive predictive value and sensitivity in patients with tertiary hyperparathyroidism. Sestamibi scanning is particularly valuable in this patient population since the incidence of ectopic glands may be higher than previously recognized.