Skip to main content
SpringerLink
Log in

The Negative Sestamibi Scan: Is a Minimally Invasive Parathyroidectomy Still Possible?

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Tc-99-sestamibi scanning is utilized to determine whether patients with primary hyperparathyroidism (HPT) are candidates for minimally invasive parathyroidectomy (MIP). However, if the result of this scan is negative, many surgeons recommend bilateral parathyroid exploration because of possible multi-gland disease. The objectives of this study were to determine whether patients with primary HPT and negative sestamibi scans can benefit from additional imaging studies and are still potential candidates for MIP.

Methods

Between March 2001 and April 2006, 578 consecutive patients with HPT underwent parathyroidectomy by a single surgeon. Pre-operative sestamibi scans had been done in 458 (79%) of these patients, 90 (20%) of which had negative results. These patients formed our study cohort.

Results

Of the 90 patients, 60 (67%) had a single adenoma, 17 (19%) double adenomas and 13 (14%) 3- to 4-gland hyperplasias. In 74 (82%) patients, localization was further investigated with one or more studies including thallium subtraction scans (n = 30), ultrasound (n = 15) and intra-operative internal jugular venous sampling (n = 49). Additionally, the use of radio-guided techniques intra-operatively facilitated minimally invasive techniques. Of these 90 patients, 47 had positive results from preoperative studies, including 12 positive thallium, 5 positive ultrasound and 13 positive internal jugular sampling results. In addition, positive results were observed for 17 patients using radio-probe techniques in the operating room. Accordingly, minimally invasive techniques were attempted in these 47 patients; 42 (89%) had single adenomas and in 5 the technique was converted to bilateral exploration for double adenoma/hyperplasia. In the setting of a negative sestamibi, the sensitivities of thallium scans and ultrasound were 30% and 27%, respectively. The overall cure rate in the 90 patients with negative sestamibi scans was 99%.

Conclusion

In patients with primary HPT and a negative sestamibi scan, most patients (67%) will have a single adenoma. These patients benefitted from additional localization tests, which yielded a positive result in 52% of patients. Therefore, even in the setting of a negative sestamibi scan, the majority of patients with primary HPT are still candidates for MIP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

FIG. 1.

Similar content being viewed by others

REFERENCES

  1. Chen H, Sokoll LJ, Udelsman R. Outpatient minimally invasive parathyroidectomy: a combination of sestamibi-SPECT localization, cervical block anesthesia, and intraoperative parathyroid hormone assay. Surgery 1999; 126:1016–1021

    Article  PubMed  CAS  Google Scholar 

  2. Satchie B, Chen H. Radioguided techniques for parathyroid surgery. Asian J Surg 2005; 28:77–81

    Article  PubMed  Google Scholar 

  3. Delbridge LW, Dolan SJ, Hop TT, Robinson BG, Wilkinson MR, Reeve TS. Minimally invasive parathyroidectomy: 50 consecutive cases. Med J Aust 2000; 172:418–422

    PubMed  CAS  Google Scholar 

  4. Bergenfelz A, Lindblom P, Tibblin S, Westerdahl J. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial. Ann Surg 2002; 236:543–551

    Article  PubMed  Google Scholar 

  5. Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 2002; 235:665–670

    Article  PubMed  Google Scholar 

  6. Bergenfelz A, Lindblom P, Tibblin S, Westerdahl J. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial. Ann Surg 2002; 236:543–551

    Article  PubMed  Google Scholar 

  7. Goldstein RE, Blevins L, Delbeke D, Martin WH. Effect of minimally invasive radioguided parathyroidectomy on efficacy, length of stay, and costs in the management of primary hyperparathyroidism. Ann Surg 2000; 231:732–742

    Article  PubMed  CAS  Google Scholar 

  8. Chen H. Radioguided Parathyroid surgery. Adv Surg 2004; 38:377–392

    PubMed  Google Scholar 

  9. Chen H, Mack E, Starling JR. Radioguided parathyroidectomy is equally effective for both adenomatous and hyperplastic glands. Ann Surg 2003; 238:332–337

    Article  PubMed  Google Scholar 

  10. Chen H, Pruhs Z, Starling JR, Mack E. Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy. Surgery 2005; 138:583–587

    Article  PubMed  Google Scholar 

  11. Ito F, Sipple R, Lederman J, Chen H. The utility of intraoperative bilateral internal jugular venous sampling with rapid parathyroid hormone testing. Ann Surg 2007 (in press)

  12. Irvin GL, III, Solorzano CC, Carneiro DM. Quick intraoperative parathyroid hormone assay: surgical adjunct to allow limited parathyroidectomy, improve success rate, and predict outcome. World J Surg 2004; 28:1287–1292

    Article  PubMed  Google Scholar 

  13. Chen H, Mack E, Starling JR. A comprehensive evaluation of perioperative adjuncts during minimally invasive parathyroidectomy: which is most reliable? Ann Surg 2005; 242:375–380

    PubMed  Google Scholar 

  14. Siegel A, Alvarado M, Barth RJ, Jr., Brady M, Lewis J. Parameters in the prediction of the sensitivity of parathyroid scanning. Clin Nucl Med 2006; 31:679–682

    Article  PubMed  Google Scholar 

  15. Casas AT, Burke GJ, Sathyanarayana, Mansberger AR, Jr., Wei JP. Prospective comparison of technetium-99m-sestamibi/iodine-123 radionuclide scan versus high-resolution ultrasonography for the preoperative localization of abnormal parathyroid glands in patients with previously unoperated primary hyperparathyroidism. Am J Surg 1993; 166:369–373

  16. Haber RS, Kim CK, Inabnet WB. Ultrasonography for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism: comparison with (99m)technetium sestamibi scintigraphy. Clin Endocrinol (Oxf) 2002; 57:241–249

    Article  Google Scholar 

  17. Frydman J, Bianco J, Drezner M, Chen H. Thallium-pertechnetate subtraction scanning in the preoperative localization of an ectopic undescended parathyroid gland. Clin Nucl Med 2004; 29:542–544

    Article  PubMed  Google Scholar 

  18. Reidel MA, Schilling T, Graf S, Hinz U, Nawroth P, Buchler MW, Weber T. Localization of hyperfunctioning parathyroid glands by selective venous sampling in reoperation for primary or secondary hyperparathyroidism. Surgery 2006; 140:907–913

    Article  PubMed  Google Scholar 

  19. Sugg SL, Fraker DL, Alexander R, Doppman JL, Miller DL, Chang R, Skarulis MC, Marx SJ, Spiegel AM, Norton JA. Prospective evaluation of selective venous sampling for parathyroid hormone concentration in patients undergoing reoperations for primary hyperparathyroidism. Surgery 1993; 114:1004–1009

    PubMed  CAS  Google Scholar 

  20. Clark OH, Okerlund MD, Moss AA, Stark D, Norman D, Newton TH, Duh QY, Arnaud CD, Harris S, Gooding GA. Localization studies in patients with persistent or recurrent hyperparathyroidism. Surgery 1985; 98:1083–1094

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, H4/750 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA

    Alysandra Lal MD & Herbert Chen MD, FACS

Authors
  1. Alysandra Lal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Herbert Chen MD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Herbert Chen MD, FACS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lal, A., Chen, H. The Negative Sestamibi Scan: Is a Minimally Invasive Parathyroidectomy Still Possible?. Ann Surg Oncol 14, 2363–2366 (2007). https://doi.org/10.1245/s10434-007-9451-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-007-9451-3

Keywords

Search

Navigation