engleski

Correlation of preoperative 99mTc-sestamibi parathyroid scintigraphy to the size of enlarged parathyroid glands in patients undergoing surgery for hyperparathyroidism

Aim: To establish sensitivity of preoperative parathyroid planar scintigraphy comparing scintigraphic findings to the size of surgically removed enlarged parathyroid glands. Methods: We studied 40 consecutive patients who underwent parathyroidectomy at the Surgery Clinic of our hospital, 32 of them with primary hyperparathyroidism, and 8 with secondary hyperparathyroidism. All patients were preoperatively administered 555 MBq 99mTc- sestamibi intravenously. Planar images of the neck were obtained at 15 minutes and again at 1 and 3 hours. Scintigraphy was considered positive in the presence of the focal area retaining activity on delayed images. Preoperative scintigraphic and sonographic findings were compared to the size of surgically removed nodes, subsequently pathohistologically diagnosed either as parathyroid adenomas or nodular hyperplasia. Results: Among 32 patients with primary hyperparathyroidism, 27 of them (84%) had positive scintigraphy in terms of retaining activity focus at the location where node was removed during surgery, and pathohistologically diagnosed as parathyroid adenoma. The largest diameters of those nodes were equal to or greater than 10 mm. All of those were seen by preoperative sonography, except 2 substernally located and found during surgery owing to their increased activity. In 5, out of 32 patients with primary hyperparathyroidism scintigraphic findings were equivocal (16%). In 4 of those pathohistology of the removed node verified parathyroid adenoma measuring less than 10 mm. Two of those were seen by sonography. In one patient with negative both scintigraphic and sonographic findings, no parathyroid tissue in surgically extirpated sample was histologically found. In the group of patients with secondary hyperparathyroidism, more parathyroid glands with nodular hyperplasia were removed, scintigraphic results were positive for all except two larger than 10 mm (86%), and were equivocal for all measuring less than 10 mm. Enlarged parathyroid glands were seen by sonography in 7 of 8 patients with secondary hyperparathyroidism. Conclusion: Preoperative scintigraphy approved absolute sensitivity (100%) in detection of parathyroid adenomas in primary hyperparathyroidism if their size was equal to or larger than 10 mm. For adenomas measuring less than 10 mm scintigraphy was mostly equivocal. Scintigraphy had high sensitivity (86%) also in detection of parathyroid glands with nodular hyperplasia measuring more than 10 mm in patients with secondary hyperparathyroidism, while for those measuring less than 10 mm sensitivity was poor (<10%).

parathyroid scintigraphy ; hyperparathyroidism

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