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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2011

01-10-2011 | Endocrine Tumors

What is the Added Benefit of Cervical Ultrasound to 99mTc-Sestamibi Scanning in Primary Hyperparathyroidism?

Authors: Joel T. Adler, MD, Herbert Chen, MD, FACS, Sarah Schaefer, NP, Rebecca S. Sippel, MD, FACS

Published in: Annals of Surgical Oncology | Issue 10/2011

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Abstract

Background

Minimally invasive parathyroidectomy for primary hyperparathyroidism depends on accurate preoperative imaging, which is traditionally accomplished by 99mTc-sestamibi scanning. Cervical ultrasound is gaining in use, but it is unclear how much information it adds to the routine use of 99mTc-sestamibi scans.

Methods

A prospectively maintained database of patients undergoing parathyroidectomy for primary hyperparathyroidism was queried, and the utility of cervical ultrasound in preoperative planning was analyzed.

Results

Between July 2002 and November 2009, 310 patients with primary hyperparathyroidism underwent both 99mTc-sestamibi and ultrasound imaging. Ultrasound added new information to 99mTc-sestamibi in 43 patients (14%) by finding either the correct enlarged gland (n = 40, 88%) or additional enlarged glands (n = 5, 12%). Ultrasound correctly localized glands in 38 of 85 (45%) patients with a negative 99mTc-sestamibi, allowing for a minimally invasive parathyroidectomy in those patients. However, in the 206 patients (66%) who had a 1-gland positive 99mTc-sestamibi, ultrasound only added information for 8 patients (4%). When compared with radiology-performed ultrasound, surgeon-performed ultrasound was successful in localizing additional glands in 27 (15%) versus 17 patients (10%) (P < 0.001).

Conclusions

Ultrasound led to additional localization information in 14% of patients, although this benefit was less in patients with a clearly positive 1-gland 99mTc-sestamibi scan. Cervical ultrasound provides added benefit to 99mTc-sestamibi scanning in patients with primary hyperparathyroidism, but its greatest utility is when performed by a surgeon in patients with a negative 99mTc-sestamibi scan.
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Metadata
Title
What is the Added Benefit of Cervical Ultrasound to 99mTc-Sestamibi Scanning in Primary Hyperparathyroidism?
Authors
Joel T. Adler, MD
Herbert Chen, MD, FACS
Sarah Schaefer, NP
Rebecca S. Sippel, MD, FACS
Publication date
01-10-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 10/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1724-1

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