A. Kumar et al., Sestamibi scan-directed unilateral neck exploration for primary hyperparathyroidism due to a solitary adenoma, EUR J SUR O, 26(8), 2000, pp. 785-788
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.