PREOPERATIVE TECHNETIUM TC 99M SESTAMIBI IMAGING - PAVING THE WAY TO MINIMAL-ACCESS PARATHYROID SURGERY

Objective: To examine the reliability of technetium Tc 99m sestamibi s canning as a new adjunct to the surgical management of hyperparathyroi dism. Design: Preoperative localization of parathyroid adenoma by tech netium Tc 99m sestamibi delayed washout scanning and high-resolution u ltrasound was compared with a historical institutional experience of s urgical intervention without preliminary localization studies. A 10-ye ar retrospective review from 1985 to 1995 of patients with surgical hy perparathyroidism was performed. Setting: Academic tertiary referral m edical center. Patients: Thirty-three technetium Tc 99m sestamibi scan s in patients with primary hyperparathyroidism were correlated with ev entual surgical and pathologic findings. The last 10 patients were als o studied with 10-MHz linear transducer ultrasound, and the results we re compared with those of the radionuclide scan and eventual surgical and pathologic findings. From 1985 to 1995, 142 patients underwent sur gical exploration for primary hyperparathyroidism, and 125 records wer e available for review. Results: The technetium Tc 99m sestamibi parat hyroid scan correctly identified the site and presence of 31 adenomas among 34 confirmed tumors, a sensitivity of 91% and positive predictiv e value of 97%. The scan detected three anterior mediastinal adenomas that could not be removed through cervical exploration. In each instan ce, median sternotomy was included in the primary surgery and allowed efficient, successful management of these ectopic adenomas. High-resol ution ultrasound correctly identified nine of 10 cervical parathyroid adenomas and predicted the volume of each tumor to a statistically sig nificant level. Conclusion: Hyperparathyroidism has traditionally been treated surgically without preliminary localization studies. We found both technetium Tc 99m sestamibi scanning and high-resolution ultraso und to be highly sensitive at detecting parathyroid adenomas at the 90 % level. Furthermore, preoperative localization allowed efficient surg ical intervention for our group of patients who had a high frequency o f mediastinal adenomas that required transmediastinal surgery.