Methylene blue and sestamibi: Complementary tools for localizing parathyroids

Objective. To determine the value and correlation between sestamibi scan an d methylene blue staining for localization of parathyroid glands in patient s with primary hyperparathyroidism. Study Design: Nonrandomized convenience sample, followed prospectively. Methods. Twenty-three consecutive patients underwent 24 operations for primary hyperparathyroidism. All. patients und erwent preoperative technetium. 99m-sestamibi planar scintigraphy, preopera tive administration of 7.5 mg/kg methylene blue initiated within 60 minutes of surgical incision, and surgical neck exploration supervised by a single surgeon. Results: All patients were cured of hypercalcemia. Sensitivity fo r sestamibi and for methylene blue staining was 76% and 79%, respectively. Specificity for sestamibi and for methylene blue was 98% and 93%, respectiv ely. Agreement between sestamibi and methylene blue was 96%. Conclusions. S estamibi scanning and methylene blue staining are useful, complementary loc alizing tools for patients undergoing surgery for primary hyperparathyroidi sm. When used together, these studies decrease operative time, justify unil ateral exploration in patients with parathyroid adenoma, and increase the e ase of identification of hyperplastic parathyroid glands.