EFFICACY OF PREOPERATIVE DIAGNOSTIC-IMAGING LOCALIZATION OF TECHNETIUM 99M SESTAMIBI SCINTIGRAPHY IN HYPERPARATHYROIDISM

Background. Until now, preoperative parathyroid imaging has been consi dered unnecessary because currently available techniques do not provid e any better results than an expert surgeon. We conducted a multicente r prospective study evaluating the capability of technetium 99m sestam ibi scintigraphy in the preoperative identification of pathologic glan ds. Methods. Ninety-three patients with hyperparathyroidism, seven of them reoperative cases, were studied. In addition, 20 age-matched norm ocalcemic control subjects were also studied. Results. Surgical confir mation of scintigraphic images was obtained in 91 of 93 cases (sensiti vity, 97.8%). In all reoperative cases (n = 7), in all cases of ectopi c glands (whether operated or not; n = 6), and in all patients with a single-gland disease (n = 70), topographic identification of the patho logic gland was correct in 100%. In multiple-gland disease (n = 23), i nvolvement of more than one gland was visualized in only 61% of the pa tients; however, in 91% of patients, at least one gland was localized. Surgical success-defined as postoperative normocalcemia-with this app roach was 100%. All scans of normocalcemic control subjects were negat ive. Of 31 patients in whom a multinodular goiter coexisted, seven pre sented a significant radionuclide background at 120 minutes' scan. Fal se-positive images were found together with those corresponding to the pathologic glands in only three cases. Conclusions. Tc-99m-sestamibi is a highly reliable, sensitive, and specific technique for imaging of pathologic glands in hyperparathyroidism, especially in single-gland disease. It may be considered as a first line single-procedure when a preoperative topographic diagnosis is required.