SESTAMIBI SCANNING IS INADEQUATE FOR DIRECTING UNILATERAL NECK EXPLORATION FOR FIRST-TIME PARATHYROIDECTOMY

Objective: To determine whether technetium Tc 99m sestamibi scanning i s accurate enough to allow surgeons to perform unilateral neck explora tion for first-time parathyroidectomy in patients with primary hyperpa rathyroidism. Design: Retrospective review. Setting: University tertia ry care center. Patients: Forty patients with primary hyperparathyroid ism who underwent sestamibi scanning before first-time parathyroidecto my, of whom 28 had single adenomas, 9 had multiple adenomas, and 3 had hyperplasia. Interventions: All 40 patients underwent bilateral neck exploration with identification of 4 parathyroid glands. Main Outcome Measures: We compared the results of preoperative sestamibi scanning w ith operative and histologic findings. We then used these data to calc ulate the projected success rates of parathyroidectomy if unilateral n eck explorations had been performed based on the results of sestamibi scanning, instead of bilateral explorations. Results: Sestamibi scanni ng was correct in 20 (71%) of 28 patients with single adenomas, 4 (44% ) of 9 patients with multiple adenomas, and 0 (0%) of 3 patients with hyperplasia. If unilateral neck explorations had been performed on the basis of localization by sestamibi scanning, parathyroidectomy would have failed in 4 (10%) of 40 patients. Conclusions: Sestamibi scanning , although helpful, is inadequate for directing unilateral neck explor ation for first-time parathyroidectomy. Surgeons who perform unilatera l neck exploration based on the results of sestamibi scanning will rec ord a higher failure rate and incur higher costs than those who perfor m bilateral neck exploration for first-time parathyroidectomy.