IMPACT OF TECHNETIUM-99M-SESTAMIBI LOCALIZATION ON OPERATIVE TIME ANDSUCCESS OF OPERATIONS FOR PRIMARY HYPERPARATHYROIDISM

Intraoperative identification of abnormal parathyroid glands during in itial neck exploration for primary hyperparathyroidism is challenging and may require extensive dissection of the neck and mediastinum. We, therefore, evaluated the impact of preoperative localization with Tech netium-99m-sestamibi (Tc-99m-sestamibi) and Iodine-123 radionuclide su btraction imaging on operative time and success of initial operation f or primary hyperparathyroidism. From January 1989 to September 1992, 4 2 patients underwent neck exploration for primary hyperparathyroidism; 21 patients underwent neck exploration without preoperative radionucl ide scanning, and 21 patients were operated upon following radionuclid e Tc-99m-sestamibi localization. In the control group, pathologic exam revealed 15 patients had solitary adenomas, and six patients had diff use hyperplasia. In the Tc-99m-sestamibi group, 16 patients had solita ry adenomas, four had diffuse hyperplasia, and one had multiple adenom as. Analysis of patient demographic data revealed no differences betwe en the control group and the Tc-99m-sestamibi group in mean age (56 vs 59 years), mean intact PTH levels (249 vs 234 pg/mL), mean total calc ium (11.3 vs 12.0 mg/dL), and mean ionized calcium (6.19 vs 6.28 mg/dL ). Comparison of operative data revealed no differences between groups in the mean number of parathyroid glands identified and biopsied per patient (3.1 vs 3.3), the mean largest diameter of the resected adenom as (19.6 vs 20.0 mm), and the number of patients requiring thymectomy, thyroid resection, retroesophageal exploration, mediastinal explorati on, or carotid sheath exploration. The operative success rate was 90 p er cent for the control group versus 100 per cent for the Tc-99m-sesta mibi group. The mean operative time was significantly different, 180 /- 45 minutes in the control group versus 135 +/- 52 minutes in the Tc -99m-sestamibi group (P < 0.01). Preoperative parathyroid localization with the Tc-99m-sestamibi scan reduced the operative time and may hav e contributed to the improved rate of operative success in patients un dergoing neck exploration for primary hyperparathyroidism.