Sestamibi scan-directed unilateral neck exploration for primary hyperparathyroidism due to a solitary adenoma

Aim: To evaluate the accuracy of Tc-99m sestamibi scintigraphy in pre-opera tive localization of a single parathyroid adenoma and to determine if neck exploration can be limited to the side of the adenoma. Methods: Over a period of 4 years, 30 patients with primary hyperparathyroi d disease underwent surgical treatment in the form of unilateral neck explo ration after localization by Tc-99m sestamibi scintigraphy. The scan findin gs were interpreted by one radiologist with a special interest in parathyro id imaging and the operative findings were correlated with scan findings. Results: Tc-99 sestamibi scan localized a single parathyroid adenoma in 29 patients. There was doubtful uptake of isotope in one patient. Unilateral c ervical exploration confirmed isotope scan findings in 29 patients with a p ositive scan, and these were subsequently proven by histology. In the patie nt with doubtful sestamibi scan, bilateral neck exploration was undertaken and three enlarged glands were excised. All the three glands were reported to be abnormal, consistent with either adenomas or hyperplasia. All the pat ients were normocalcaemic after 6 months follow-up. Conclusions: Our results demonstrate that Tc-99m sestamibi scintigraphy is highly accurate in pre-operative localization of a single parathyroid adeno ma when performed by an experienced radiologist. Unilateral cervical explor ation, as directed by a positive Tc-99m sestamibi scintigram, seems to be a logical approach for the patients with primary hyperparathyroid disease du e to solitary adenoma. (C) 2000 Harcourt Publishers Ltd.