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Nicholas Y. Mehta, MD; James M. Ruda, BS; Silloo Kapadia, MD; Phillip J. Boyer, MD, PhD; Christopher S. Hollenbeak, PhD; Brendan C. Stack, Jr, MD

Arch Otolaryngol Head Neck Surg. 2005;131:493-498.

Objective  To investigate the histopathological features of pathologic parathyroid specimens associated with negative preoperative technetium Tc 99m sestamibi scans.

Design  Retrospective study.

Setting  Tertiary care center.

Patients  One hundred fourteen patients who underwent sestamibi scans before surgical exploration for primary hyperparathyroidism between 1996 and 2001.

Interventions  Surgical exploration and removal of parathyroid adenomas.

Main Outcome Measures  Histopathological characteristics associated with true-positive and false-negative sestamibi scans, including parathyroid specimen weight, size, relative oxyphil and chief cell content, parathyroid hormone staining patterns, cellular architecture, and various immunohistochemical staining patterns.

Results  Twenty-three (24%) of 98 patients with parathyroid adenomas had negative sestamibi scan results. Among 20 age- and sex-matched patients with false-negative results vs 20 patients with true-positive results, tumor size (P = .04) and oxyphil cell content (P = .03) were found to be significantly different.

Conclusion  Parathyroid gland size and oxyphil content are descriptive and predict differences between sestamibi properties of parathyroid adenomas but have no current therapeutic implications for parathyroid surgery.

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio (Dr Mehta); Departments of Pathology (Dr Kapadia) and Surgery and Health Evaluation Sciences (Dr Hollenbeak) and Division of Otolaryngology–Head and Neck Surgery (Dr Stack), Pennsylvania State University College of Medicine, Hershey; Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Boyer); and Department of Health Studies, Lehigh Valley Hospital, Allentown, Pa (Dr Hollenbeak). Mr Ruda is a student at Pennsylvania State University College of Medicine.

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