Hernández MV, Guillén GMÁ, Vergara LA

Language: Spanish
References: 10
Page: 21-25
PDF size: 82.67 Kb.

ABSTRACT

The most frequently performed localizing study in the evaluation of the patient with hyperparathyroidism is the parathyroid scintigraphy with Tc99m-sestamibi. Yet, the sensitivity of the study varies according to the equipment used and the experience of the interpreter. The objective of this study was to correlate the results of the parathyroid scintigraphy with both, the surgical findings and the final histopathological report. We studied 60 patients with primary hyperparathyroidism seen in our Service between 2001 and 2008; all of them were evaluated with a parathyroid Tc99m-sestamibi scintigraphy and were later-on subjected to surgery. Forty nine of the 60 patients had positive studies (81.6%); uptake was demonstrated on one site in 47 patients and on 2 sites on 2 patients. Surgical findings corroborated the results of the parathyroid scan in 42 of the 49 patients with a positive study; in 7 of them, the localization was different to that reported in the scan. The presence of an adenoma was confirmed histopathologically in 44 of the 49 patients with a positive scan and in 9 of the 11 patients with a negative scan. When considering the surgical finding, the sensitivity and positive predictive value of the parathyroid scan was 82% and 85%, respectively, whereas when taking into account the histopathological report these figures were 83% and 89%. We conclude that in our Service, the parathyroid scan has a similar sensitivity to that reported in other international specialized centers and thus may aid in the planning of the surgical approach.

REFERENCES

1. Potts JT Jr, Fradkin JE, Aurbach GD, Bilezikian JP, Raisz LG. Proceedings of the NIH consensus development conference on diagnosis and management of asymptomatic primary hyperparathyroidism. J Bone Miner Res 1991: 6(Suppl 2).

2. Bilezikian JP, Silverberg SJ. Asymptomatic primary hyperparathyroidism. N Engl J Med 2004; 350: 1746-51.

3. Bilezikian JP, Potts JT Jr, Fuleihan GH et al. Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for 21st century. J Bone Miner Res 2002; 17(Suppl 2): N2-N11.

4. Udelsman R, Pasieka JL, Sturgenon C, Young JEM, Clark OH. Surgery for asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab 2009; 94: 366-372.

5. Denham DW, Norman J. Cost-effectiveness of preoperative sestamibi scan for primary hyperparathyroidism is dependent solely upon the surgeon’s choice of operative procedure. J Am Coll Surg 1998; 186: 293-305.

6. Grant CS, Thompson G, Farley D, van Heerden J. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy. Arch Surg 2005; 150: 472-479.

7. Civelek AC, Ozalp E, Donovan P, Udelsman R. Prospective evaluation of delayed technetium-99m sestamibi SPECT scintigraphy for preoperative localization of primary hyperparathyroidism. Surgery 2002; 131: 149-157.

8. Ponce JL, Meseguer M, Sebastián C. Avances en el tratamiento del hiperparatiroidismo primario. Cir Esp 2003; 74(1): 4-9.

9. Ryan JA, Lee FT. Maximizing outcomes while minimizing exploration in hyperparathyroidism using localization test. Arch Surg 2004; 139: 838-843.

10. Chan RK, Ruan DT, Gawande AA, Moore FD. Surgery for hyperparathyroidism in image-negative patients. Arch Surg 2008; 143(4): 335-337.