Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91patients with primary hyperparathyroidism

Objective: To evaluate the usefulness of the combination of Tc-99m-sestamib i/Tc-99m-pertechnetate subtraction scintigraphy (SS) and high-resolution ne ck ultrasonography (US) in patients with primary hyperparathyroidism (pHPT) undergoing parathyroidectomy. Design and Methods: Ninety-one patients with proved pHPT were studied, excl uding patients with persistent or recurrent disease. There were 65 (71.4%) women and 26 (28.6%) men, with a median age of 59 years (range 18-78 years) . All patients underwent both SS and US prior to surgery. and the results w ere compared with operative and histological findings. The intraoperative q uick-parathyroid hormone assay was available for 52 (57.1%) patients. When multiglandular disease was found, both SS and US wore considered truly posi tive only when at least true enlarged parathyroid (PT) glands had been loca lized. Results: Eighty-three (91.2%) solitary PT adenomas and three (3.3%) carcino mas were found. Moreover two (2.2%) patients had a double adenoma and three (3.3%) patients had diffuse PT hyperplasia. The overall sensitivity of com bined SS + US was 94.5% (86.8% and 80.4% for SS and US respectively). There was a significant (P < 0.05, Student's t-test) difference in size between the PT glands correctly identified and undetected by SS, whereas the site o f the removed PT tumors significantly (P < 0.05, Fisher exact test) influen ced only the US sensitivity. Conclusions: When the preoperative localization of the PT glands is chosen, the combination of SS and US represents a reliable noninvasive localizatio n technique and should be considered for use in each patient with pHPT unde rgoing surgery.