Additional Imaging Following a Negative Sestamibi Scan in Primary Hyperparathyroidism

Bas Twigt,Anne Vollebregt,Piet De Hooge,Thijs Van Dalen,Alex Muller

doi:10.4236/ijohns.2012.13019

Abstract

Background: The objective of this study was to assess the additional yield of US and CT following a “negative” initial MIBI-scintigraphy (MIBI) in patients with primary hyperparathyroidism. Methods: Prospective data were collected regarding 100 consecutive patients, preferentially undergoing a minimally invasive parathyroidectomy (MIP). MIBI was the initial imaging study for localizing a solitary adenoma, followed by US and CT (US/CT) in “MIBI-negative”-patients. Results: Surgery led to normocalcemia in 98 patients (98%) after one operation. Overall 97 patients had solitary parathyroid disease while three patients had multiglandular disease. The sensitivity of imaging increased from 74% for MIBI alone to 92% following subsequent US/CT in “MIBI-negative”-patients. The positive predictive value of a “positive” MIBI was 96% and 76% of a positive US/CT following negative MIBI. The proportion of patients who underwent successful MIP increased from 60 to 72%. Conclusions: MIBI and the combination of US and CT are complementary imaging studies. Additional localization studies after a negative sestamibi scan enhances the number of patients with primary hyperparathyroidism profiting from a minimally invasive approach.

Highlights

Primary hyperparathyroidism (PHPT) affects 0.3% of the general population and the incidence is 21.6 cases per 100,000 person-years [1,2]
The objective of this study was to assess the additional yield of US and CT following a “negative” initial MIBI-scintigraphy (MIBI) in patients with primary hyperparathyroidism
minimally invasive parathyroidectomy (MIP) reduces the extent of surgical dissection, operative time, hospital stay and perioperative morbidity, [3,4,5,6,7] while cure rates are comparable to the results of conventional neck exploration (CNE) [8]

Summary

Introduction

Primary hyperparathyroidism (PHPT) affects 0.3% of the general population and the incidence is 21.6 cases per 100,000 person-years [1,2]. In the last two decades minimally invasive parathyroidectomy (MIP) has gradually replaced conventional neck exploration (CNE) as the surgical procedure of choice in patients with sporadic primary hyperparathyroidism (pHPT). Preoperative parathyroid adenoma localization and intra-operative PTH-assessment (IOPTH) both contributed to this success [9,10]. The objective of this study was to assess the additional yield of US and CT following a “negative” initial MIBI-scintigraphy (MIBI) in patients with primary hyperparathyroidism. MIBI was the initial imaging study for localizing a solitary adenoma, followed by US and CT (US/CT) in “MIBI-negative”-patients. The sensitivity of imaging increased from 74% for MIBI alone to 92% following subsequent US/CT in “MIBI-negative”-patients. Additional localization studies after a negative sestamibi scan enhances the number of patients with primary hyperparathyroidism profiting from a minimally invasive approach

Objectives

Methods

Results

Conclusion