Parathyroid localization with high-resolution ultrasound and technetium Tc99m sestamibi

Hypothesis: High-resolution ultrasound and technetium Tc 99m sestamibi scan ning can be used for preoperative localization of abnormal parathyroid glan ds in patients with hyperparathyroidism. Design: Ultrasound and sestamibi scanning were performed in patients underg oing neck exploration for hyperparathyroidism. If the 2 scans agreed in ide ntifying a single adenoma, and surgery confirmed the location of a single a denoma and an ipsilateral normal gland, a unilateral exploration was perfor med. Setting: University tertiary care center. Patients: Sixty-one consecutive patients undergoing surgery for hyperparath yroidism from September 1, 1994, through September 30, 1997. Interventions: High-resolution ultrasound was performed in 59 patients and sestamibi scanning in 58 patients; all patients underwent neck exploration by a single surgeon. Main Outcome Measures: The results of preoperative ultrasound and sestamibi scanning were compared with operative and histological findings. Results: All patients were cured of hypercalcemia. Specificity of ultrasoun d and sestamibi scanning was 98% and 99%, respectively; however, their sens itivity was only 57% and 54%, respectively. Both imaging modalities had low er sensitivities in the setting of multigland disease. If both imaging stud ies were considered as a single test, sensitivity for imaging in patients w ith primary hyperparathyroidism reached 78%. Our localization protocol allo wed a unilateral approach in 43% of patients (23 of 53). Conclusions: These results confirm the value of preoperative localization i n patients with hyperparathyroidism. A unilateral approach can be used with a high degree of success in cases when ultrasound and sestamibi scanning a gree in the identification of a single adenoma confirmed by surgical explor ation with the identification of a normal ipsilateral gland.