Reply

Abstract

Dr Hodin asks an important question regarding our article1Arici C Cheath WK Ituarte PHG Morita E Lynch TC Siperstein AE et al.Can localization studies be used to direct focused parathyroid operation?.Surgery. 2001; 129: 720-729Abstract Full Text Full Text PDF PubMed Scopus (176) Google Scholar: “In patients having a sestamibi scan showing a single adenoma, how many patients ultimately proved to have either multi-gland disease or a different location for the single adenoma?” Among our 237 patients with primary sporadic hyperparathyroidism, there were 8 (3.4%) false-positive sestamibi scans (a probable parathyroid tumor was identified at 1 site, but at the time of the operation the parathyroid gland was situated at another site and the patient was normocalcemic postoperatively). In 7 of these 8 patients, there was a single adenoma at another site. This observation does not mean that the sestamibi scan was correct in 96% of the patients, because 1 or no abnormal glands were seen in some patients with multiple abnormal parathyroid glands. As mentioned in the text, among the 34 patients with multiple abnormal parathyroid glands who had sestamibi scans, only 3 of 15 patients (20%) with double adenomas and none of 19 patients with more than 2 abnormal parathyroid glands had all of the abnormal glands correctly identified. In 14 of these patients, no abnormal parathyroid glands were identified; and in 20 patients, 1 or more abnormal glands were identified. Thus, although sestamibi scanning is very helpful for identifying solitary parathyroid adenomas, it is not very accurate in patients with multiple abnormal parathyroid glands (20 of 54 patients, or 32%). However, when sestamibi and ultrasonography scans both independently identified the same parathyroid gland and no other tumors, they were correct in 96% of patients.