Preoperative Localization of Parathyroid Adenoma with Sonography and 99mTc-Sestamibi Scintigraphy in Primary Hyperparathyroidism

Department of Clinical Pathophysiology, University of Torino, Torino 10126, ItalyReceived 23 February 2006; accepted 14 December 2006ABSTRACT: Purpose. To evaluate the sensitivity,specificity, and usefulness of dual-phase 99mTc-Ses-tamibi scintigraphy (SS) and sonography (US) of theneck, alone and in combination, as noninvasive ade-noma localizing procedures in patients with primaryhyperparathyroidism prior to parathyroidectomy.Methods. We retrospectively analyzed the charts of79 patients with parathyroid (PT) adenomas and con-firmed diagnosis of hyperparathyroidism who wereevaluated with SS and US prior to successful para-thyroidectomy.Results. Ninety-three adenomas were removedduring bilateral neck exploration. SS alone showeda sensitivity of 76% and a specificity of 79% com-pared with 89% and 75%, respectively, for US per-formed after SS on the same day. Combination ofthe 2 procedures yielded a sensitivity of 89% and aspecificity of 90%, with 22% discordant results. Thedifferences in sensitivity and specificity between the2 techniques alone or in combination were not stat-istically significant.Conclusions. No benefit was gained from usingboth SS and US for the preoperative localization ofPT adenomas in patients with primary hyperparathy-roidism. Each technique can be negatively affected bythyroid enlargment and nodularity. US, when per-formed by a skilled operator, is a reliable tool for PTadenoma localization. If the US findings are inconclu-sive, SS should be used.