Ultrasound and sestamibi scan as the only preoperative imaging tests in reoperation for parathyroid adenomas

Background. In an effort to determine an efficient algorithm for the evalua tion of patients with parathyroid adenomas in the reoperative setting; we e xplored the combination of using ultrasound scans (US) and sestamibi scinti graphy as the only preoperative imaging tests. Methods. We analyzed the outcomes of 62 consecutive patients who were treat ed between January 1995 and May 1999 and who were referred for persistent p rimary hyperparathyroidism after initial surgical exploration, at which tim e no abnormal parathyroid glands had been found. Although all patients unde rwent US, computed tomography scan, magnetic resonance imaging, and sestami bi scan, we analyzed the success of localization and reoperation using only the results of US and sestamibi scan. Results, Sixty-one patients (98%) underwent curative reoperations. The sens itivity, positive predictive value, and accuracy for US were 90%, 86%, and 84%, respectively; the corresponding values for sestamibi imaging were 78%, 94%, and 74%, respectively. In 58 of 62 cases (94%) preoperative US and/or sestamibi scan accurately identified the adenoma. In 3 patients for whom c ombined US and sestamibi scan were inaccurate, 1 adenoma was found by intra operative US in the strap muscle; 1 adenoma was found by blind cervical thy mectomy, and 1 adenoma was found by planned sternotomy that was based on co mputed tomography findings. Conclusions. This study supports an algorithm of obtaining US and sestamibi scan as the initial and perhaps only preoperative localization tests for p atients with primary hyperparathyroidism after failed operation, at which t ime no abnormal glands had been found.