Sestamibi scan for preoperative localization in primary hyperparathyroidism

Abstract Introduction: Preoperative localization modalities for patients with primary hyperparathyroidism today play an important role in clinical decision making, surgical procedure, and the prognosis of patients. One of the most common preoperative imaging modalities is the sestamibi scan labeled with Technetium-99m, which is capable of determining the location of parathyroid lesions in primary hyperparathyroidism patients with high sensitivity. Methods: In this cross-sectional study, 25 patients with primary hyperparathyroidism, referred to endocrine clinic of Tabriz University of Medical Siences during 2016-2018 were enrolled. All patients underwent a preoperative Sestamibi scan. Comparing the results of the scan with the surgical findings as a standard gold method for diagnosis, the diagnostic value of the scan was evaluated for the localization of parathyroid lesions. Results: According to the items observed in surgery and pathologic findings, the sensitivity of Sestamibi scan for the localization of parathyroid lesions was 84.6%. Specificity and positive predictive value and negative predictive value were 95.6%, 89.6%, and 94.8%, respectively. A significant relationship was observed between the type of lesion and the sensitivity of Sestamibi scan (p=0.002). Conclusion: Sestamibi scan has high sensitivity and diagnostic and therapeutic value for patients with primary hyperparathyroidism. However, the existence of other pre- and intraoperative localization modalities, at the request of surgeons, is useful and warranted to reduce the rate of recurrent surgery as well as to minimize false negatives.

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S178 – Utility of CT-Sestamibi Fusion in Parathyroid Exploration

Otolaryngology ◽

10.1016/j.otohns.2008.05.352 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P135-P136

Author(s):

Michael J Clark ◽

Phillip Pellitteri

Keyword(s):

Primary Hyperparathyroidism ◽

Minimally Invasive ◽

Image Fusion ◽

Fusion Imaging ◽

Parathyroid Glands ◽

Preoperative Localization ◽

Minimally Invasive Surgical ◽

Sestamibi Imaging ◽

Invasive Surgical Approach ◽

Operative Findings

Objectives 1) Delineate the role of CT-technetium 99m sestamibi (CT-MIBI) fusion in directed parathyroidectomy. 2) Determine the clinical situations where CT-MIBI fusion would be strongly recommended. Methods Charts from 190 patients with primary hyperparathyroidism who underwent CT-MIBI mage fusion as a part of a scan directed, minimally invasive parathyroid exploration protocol were reviewed. The results of conventional sestamibi imaging and CT-MIBI image fusion were compared with operative findings. Results CT-MIBI image fusion accurately localized solitary hyperfunctional parathyroid glands in 70% of patients imaged; 55% of patients were localized with conventional sestamibi imaging. CT-MIBI fusion imaging was most accurate and predictive when conventional images suggested that the solitary gland was separated from the thyroid or when the adenoma was located in the retro-thyroidal/ retro-esophageal plane or mediastinum. Conclusions CT-MIBI image fusion is not superior to conventional sestamibi imaging when utilized for routine localization of hyperfunctional parathyroid glands. CT-MIBI fusion is of greatest benefit in guiding the directed approach to solitary glands, which are separate from the thyroid or ectopically located, regions where conventional imaging has proven to be less accurate. This imaging technique will augment the minimally invasive surgical approach in selected patients with primary hyperparathyroidism in order to further refine the focused technique. Its utility as the standard preoperative localization modality is not yet established and requires further investigation. Evaluation of differences in facility utilization with CT-MIBI image fusion and conventional sestamibi imaging may be helpful in determining its role in preoperative localization for hyperparathyroidism.

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