This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Paving the Way to Minimal-Access Parathyroid Surgery

Robert A. Sofferman, MD; Muriel H. Nathan, MD, PhD; Jonathan T. Fairbank, MD; Roger S. Foster, Jr, MD; David N. Krag, MD

Arch Otolaryngol Head Neck Surg. 1996;122(4):369-374.

Abstract
Objective
To examine the reliability of technetium Tc 99m sestamibi scanning as a new adjunct to the surgical management of hyperparathyroidism.

Design
Preoperative localization of parathyroid adenoma by technetium Tc 99m sestamibi delayed washout scanning and high-resolution ultrasound was compared with a historical institutional experience of surgical intervention without preliminary localization studies. A 10-year retrospective review from 1985 to 1995 of patients with surgical hyperparathyroidism was performed.

Setting
Academic tertiary referral medical center.

Patients
Thirty-three technetium Tc 99m sestamibi scans in patients with primary hyperparathyroidism were correlated with eventual surgical and pathologic findings. The last 10 patients were also studied with 10-MHz linear transducer ultrasound, and the results were compared with those of the radionuclide scan and eventual surgical and pathologic findings. From 1985 to 1995, 142 patients underwent surgical exploration for primary hyperparathyroidism, and 125 records were available for review.

Results
The technetium Tc 99m sestamibi parathyroid scan correctly identified the site and presence of 31 adenomas among 34 confirmed tumors, a sensitivity of 91% and positive predictive value of 97%. The scan detected three anterior mediastinal adenomas that could not be removed through cervical exploration. In each instance, median sternotomy was included in the primary surgery and allowed efficient, successful management of these ectopic adenomas. High-resolution ultrasound correctly identified nine of 10 cervical parathyroid adenomas and predicted the volume of each tumor to a statistically significant level.

Conclusions
Hyperparathyroidism has traditionally been treated surgically without preliminary localization studies. We found both technetium Tc 99m sestamibi scanning and high-resolution ultrasound to be highly sensitive at detecting parathyroid adenomas at the 90% level. Furthermore, preoperative localization allowed efficient surgical intervention for our group of patients who had a high frequency of mediastinal adenomas that required transmediastinal surgery.

(Arch Otolaryngol Head Neck Surg. 1996;122:369-374)

Author Affiliations
From the Divisions of Otolaryngology—Head and Neck Surgery (Dr Sofferman), Endocrine Surgery (Dr Foster), and Surgical Oncology (Dr Krag), Department of Surgery; Division of Endocrinology, Department of Medicine (Dr Nathan); and Division of Nuclear Medicine, Department of Radiology (Dr Fairbank); University of Vermont, Burlington. Dr Foster is now with the Department of Surgery, Crawford Long Island Hospital of Emory University, Atlanta, Ga.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The Cost-effectiveness of Additional Preoperative Ultrasonography or Sestamibi-SPECT in Patients With Primary Hyperparathyroidism and Negative Findings on Sestamibi Scans
Ruda et al.
Arch Otolaryngol Head Neck Surg 2006;132:46-53.
ABSTRACT | FULL TEXT  

Clinicopathologic and Radiopharmacokinetic Factors Affecting Gamma Probe-Guided Parathyroidectomy
Ugur et al.
Arch Surg 2004;139:1175-1179.
ABSTRACT | FULL TEXT  

Preoperative Localization and Radioguided Parathyroid Surgery
Mariani et al.
JNM 2003;44:1443-1458.
ABSTRACT | FULL TEXT  

The Impact of Sestamibi Scanning on the Outcome of Parathyroid Surgery
Allendorf et al.
J. Clin. Endocrinol. Metab. 2003;88:3015-3018.
ABSTRACT | FULL TEXT  

The Ectopic Parathyroid Adenoma: A Cost Justification for Routine Preoperative Localization With Technetium Tc 99m Sestamibi Scan
Sofferman and Nathan
Arch Otolaryngol Head Neck Surg 1998;124:649-654.
ABSTRACT | FULL TEXT  

Use of a Rapid Intraoperative Parathyroid Hormone Assay in the Surgical Management of Parathyroid Disease
Patel et al.
Arch Otolaryngol Head Neck Surg 1998;124:559-562.
ABSTRACT | FULL TEXT  

Sestamibi Scanning Is Inadequate for Directing Unilateral Neck Exploration for First-Time Parathyroidectomy
Shen et al.
Arch Surg 1997;132:969-976.
ABSTRACT