Skip to main content
Erschienen in: World Journal of Surgery 5/2006

01.05.2006

Negative Imaging Studies for Primary Hyperparathyroidism Are Unavoidable: Correlation of Sestamibi and High-Resolution Ultrasound Scanning with Histological Analysis in 150 Patients

verfasst von: Radu Mihai, MD, PhD, FRCS, Fergus Gleeson, FRCR, FRCP, Ian D. Buley, MA, BM, BCh, FRCPath, Derek E. Roskell, MA, BM, BCh, FRCPath, Gregory P. Sadler, MD, FRCS (Ed), FRCS Gen Surg (Eng)

Erschienen in: World Journal of Surgery | Ausgabe 5/2006

Einloggen, um Zugang zu erhalten

Abstract

Background

Preoperative localization studies with Tc99m-sestamibi have become an integral step in the preoperative assessment of patients with primary hyperparathyroidism (PHPT). This enables scan-directed minimally invasive parathyroidectomy (MIP) to be the preferred treatment for PHPT in many units. This study aimed to identify factors that lead to negative imaging studies in patients with PHPT.

Methods

Over a 3-year period consecutive unselected patients with PHPT underwent Tc99m-sestamibi scanning and high-resolution ultrasound (US) scanning by the same radiologist. When localization studies were concordant, patients underwent MIP. Those patients with negative imaging studies underwent bilateral neck exploration. Histology slides were independently reviewed and the proportion of chief cells and oxyphil cells within each adenoma was estimated.

Results

One hundred and fifty-eight patients underwent localization studies (38 men and120 women, aged 61.8 ± 15.2 years). Sestamibi scans were negative in 52 (32%) and positive in 106 (68%) patients. There was a higher incidence of hyperplasia in the group of patients with negative sestamibi scans (4 out of 52 vs. 4 out of 103, P < 0.05, χ2 test). In patients with negative sestamibi scans the majority of adenomas were formed predominantly from chief cells (26 out of 36) while the majority of patients with adenomas composed predominantly of oxyphil cells had positive scans (21 out of 23) (P < 0.05, χ2 test). The weight of parathyroid adenomas was higher when sestamibi scans were positive (median: 1,180 vs. 517 mg, P < 0.05, Student’s t-test).

Conclusion

Successful preoperative localization of parathyroid adenomas using Tc99m-sestamibi scanning is influenced by the cytological predominance of individual tumors. Negative scans might therefore be unavoidable in a subgroup of patients.
Literatur
1.
Zurück zum Zitat Adami S, Marcocci C, Gatti D. Epidemiology of primary hyperparathyroidism in Europe. J Bone Miner Res 2002;17(Suppl 2):N18–N23PubMed Adami S, Marcocci C, Gatti D. Epidemiology of primary hyperparathyroidism in Europe. J Bone Miner Res 2002;17(Suppl 2):N18–N23PubMed
2.
Zurück zum Zitat Melton LJ III. Epidemiology of primary hyperparathyroidism. J Bone Miner Res 1991;6(Suppl 2):S25–S30PubMedCrossRef Melton LJ III. Epidemiology of primary hyperparathyroidism. J Bone Miner Res 1991;6(Suppl 2):S25–S30PubMedCrossRef
3.
Zurück zum Zitat Doppman J. Reoperative parathyroid surgery: localization procedures, parathyroid surgery. Prog Surg 1986;18:117 Doppman J. Reoperative parathyroid surgery: localization procedures, parathyroid surgery. Prog Surg 1986;18:117
4.
Zurück zum Zitat Denham DW, Norman J. Cost-effectiveness of preoperative sestamibi scan for primary hyperparathyroidism is dependent solely upon the surgeon’s choice of operative procedure. J Am Coll Surg 1998;186:293–305CrossRefPubMed Denham DW, Norman J. Cost-effectiveness of preoperative sestamibi scan for primary hyperparathyroidism is dependent solely upon the surgeon’s choice of operative procedure. J Am Coll Surg 1998;186:293–305CrossRefPubMed
5.
Zurück zum Zitat Coackley AJ, Kettle AG, Wells CP, et al. 99Tc-sestamibi: a new agent for parathyroid imaging. Nucl Med Commun 1989;10:791–794 Coackley AJ, Kettle AG, Wells CP, et al. 99Tc-sestamibi: a new agent for parathyroid imaging. Nucl Med Commun 1989;10:791–794
6.
Zurück zum Zitat Arbab AS, Koizumi K, Toyama K, et al. Uptake of technetium-99m-tetrofosmin, technetium-99, -MIBI and thalium-201 in tumour cell lines. J Nucl Med 1996;37:1551–1556PubMed Arbab AS, Koizumi K, Toyama K, et al. Uptake of technetium-99m-tetrofosmin, technetium-99, -MIBI and thalium-201 in tumour cell lines. J Nucl Med 1996;37:1551–1556PubMed
7.
Zurück zum Zitat Hetrakul N, Civelek AC, Sragg CA, et al. In vitro accumulation of technetium-99m-sestamibi in human parathyroid mitochondria. Surgery 2001;130:1011–1018CrossRefPubMed Hetrakul N, Civelek AC, Sragg CA, et al. In vitro accumulation of technetium-99m-sestamibi in human parathyroid mitochondria. Surgery 2001;130:1011–1018CrossRefPubMed
8.
Zurück zum Zitat O’Doherty MJ, Kettle AG, Wells P, et al. Parathyroid imaging with technetium-99m-sestamibi: preoperative localization and tissue uptake studies. J Nucl Med 1992;33:313–318PubMed O’Doherty MJ, Kettle AG, Wells P, et al. Parathyroid imaging with technetium-99m-sestamibi: preoperative localization and tissue uptake studies. J Nucl Med 1992;33:313–318PubMed
9.
Zurück zum Zitat Kao A, Shiau YC, Tsai SC, et al. Technetium-99m methoxyisobutylisonitrile imaging for parathyroid adenoma: relationship to P-glycoprotein or multidrug resistance-related protein expression. Eur J Nucl Med Mol Imaging 2002;29:1012–1015CrossRefPubMed Kao A, Shiau YC, Tsai SC, et al. Technetium-99m methoxyisobutylisonitrile imaging for parathyroid adenoma: relationship to P-glycoprotein or multidrug resistance-related protein expression. Eur J Nucl Med Mol Imaging 2002;29:1012–1015CrossRefPubMed
10.
Zurück zum Zitat Sun SS, Shiau YC, Lin CC, et al. Correlation between P-glycoprotein (P-gp) expression in parathyroid and Tc-99m-MIBI parathyroid image finding. Nucl Med Biol 2001;28:929–933CrossRefPubMed Sun SS, Shiau YC, Lin CC, et al. Correlation between P-glycoprotein (P-gp) expression in parathyroid and Tc-99m-MIBI parathyroid image finding. Nucl Med Biol 2001;28:929–933CrossRefPubMed
11.
Zurück zum Zitat Taillefer R, Robidoux A, Lambert R, et al. Technetium-99m-sestamibi prone scintimammography to detect primary breast cancer and axillary lymph node involvement. J Nucl Med 1995;36:1758–1765PubMed Taillefer R, Robidoux A, Lambert R, et al. Technetium-99m-sestamibi prone scintimammography to detect primary breast cancer and axillary lymph node involvement. J Nucl Med 1995;36:1758–1765PubMed
12.
Zurück zum Zitat Yen TC, Tzen KY, Lee CM, et al. Squamous cell carcinoma of the lung mimicking an ectopic mediastinal parathyroid adenoma demonstrated by Tc-99m sestamibi in a hypercalcaemic patient. Clin Nucl Med 1999; 24:895–896CrossRefPubMed Yen TC, Tzen KY, Lee CM, et al. Squamous cell carcinoma of the lung mimicking an ectopic mediastinal parathyroid adenoma demonstrated by Tc-99m sestamibi in a hypercalcaemic patient. Clin Nucl Med 1999; 24:895–896CrossRefPubMed
13.
Zurück zum Zitat Glaser C, Pruckmayer M, Staudenherz A, et al. Utility of technetium-99m-sestamibi to assess osseous tumour spread. J Nucl Med 1996;37:1526–1528PubMed Glaser C, Pruckmayer M, Staudenherz A, et al. Utility of technetium-99m-sestamibi to assess osseous tumour spread. J Nucl Med 1996;37:1526–1528PubMed
14.
Zurück zum Zitat Kos WGM, Brown MR, Balfour JF. A false-positive localization of parathyroid adenoma with technetium Tc99m-sestamibi secondary to a thyroid follicular carcinoma. Arch Surg 1996;131:216–217 Kos WGM, Brown MR, Balfour JF. A false-positive localization of parathyroid adenoma with technetium Tc99m-sestamibi secondary to a thyroid follicular carcinoma. Arch Surg 1996;131:216–217
15.
Zurück zum Zitat Scott AM, Kostakoglu L, O’Brien JP, et al. Comparison of technetium-99m-MIBI and thalium-201-chloride uptake in primary thyroid lymphoma. J Nucl Med 1992;33:1396–1398PubMed Scott AM, Kostakoglu L, O’Brien JP, et al. Comparison of technetium-99m-MIBI and thalium-201-chloride uptake in primary thyroid lymphoma. J Nucl Med 1992;33:1396–1398PubMed
16.
Zurück zum Zitat Leslie WD, Riese KT, Mohamed C. Sestamibi retention in reactive lymph node hyperplasia: a cause of false-positive parathyroid localisation. Clin Nucl Med 2000;25:216–217CrossRefPubMed Leslie WD, Riese KT, Mohamed C. Sestamibi retention in reactive lymph node hyperplasia: a cause of false-positive parathyroid localisation. Clin Nucl Med 2000;25:216–217CrossRefPubMed
17.
Zurück zum Zitat Mudun A, Kocak M, Unal S, Cantez S, et al. Tc99m MIBI accumulation in remnant thymus: a cause of false-positive interpretation in parathyroid imaging. Clin Nucl Med 1995;20:379–380PubMedCrossRef Mudun A, Kocak M, Unal S, Cantez S, et al. Tc99m MIBI accumulation in remnant thymus: a cause of false-positive interpretation in parathyroid imaging. Clin Nucl Med 1995;20:379–380PubMedCrossRef
18.
Zurück zum Zitat Campeau RJ, Reuther WL, Wayne J. False-positive Tc99m sestamibi examination for parathyroid adenoma in a case of asymmetrical salivary gland enlargement. Clin Nucl Med 1999;24:723–724CrossRefPubMed Campeau RJ, Reuther WL, Wayne J. False-positive Tc99m sestamibi examination for parathyroid adenoma in a case of asymmetrical salivary gland enlargement. Clin Nucl Med 1999;24:723–724CrossRefPubMed
19.
Zurück zum Zitat Perez-Monte JE, Brown ML, Clarke MR, et al. Parathyroid hyperplasia, thymic carcinoid and pituitary adenoma detected with technetium 99m-MIBI in MEN type I. J Nucl Med 1997;38:1767–1769PubMed Perez-Monte JE, Brown ML, Clarke MR, et al. Parathyroid hyperplasia, thymic carcinoid and pituitary adenoma detected with technetium 99m-MIBI in MEN type I. J Nucl Med 1997;38:1767–1769PubMed
20.
Zurück zum Zitat Pattou F, Huglo D, Proye C. Radionuclide scanning in parathyroid diseases. Br J Surg 1998;85:1605–1616CrossRefPubMed Pattou F, Huglo D, Proye C. Radionuclide scanning in parathyroid diseases. Br J Surg 1998;85:1605–1616CrossRefPubMed
21.
Zurück zum Zitat Leslie WD, Dupont JO, Bybel B, et al. Parathyroid (99m)Tc-sestamibi scintigraphy: dual tracer subtraction is superior to double-phase washout. Eur J Nucl Med Mol Imaging 2002;29:1566–1570CrossRefPubMed Leslie WD, Dupont JO, Bybel B, et al. Parathyroid (99m)Tc-sestamibi scintigraphy: dual tracer subtraction is superior to double-phase washout. Eur J Nucl Med Mol Imaging 2002;29:1566–1570CrossRefPubMed
22.
Zurück zum Zitat Moka D, Voth E, Dietlein M, et al. Technetium 99m-MIBI-SPECT: a highly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery 2000;128:29–35CrossRefPubMed Moka D, Voth E, Dietlein M, et al. Technetium 99m-MIBI-SPECT: a highly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery 2000;128:29–35CrossRefPubMed
23.
Zurück zum Zitat Royal RE, Delpassand ES, Shapiro SE, et al. Improving the yield of preoperative localisation: technetium Tc 99m-sestamibi imaging after thyroid suppression. Surgery 2002;132:968–975CrossRefPubMed Royal RE, Delpassand ES, Shapiro SE, et al. Improving the yield of preoperative localisation: technetium Tc 99m-sestamibi imaging after thyroid suppression. Surgery 2002;132:968–975CrossRefPubMed
24.
Zurück zum Zitat Lumachi F, Zucchetta P, Marzola MC, et al. Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism. Eur J Endocrinol 2000;143:755–760CrossRefPubMed Lumachi F, Zucchetta P, Marzola MC, et al. Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism. Eur J Endocrinol 2000;143:755–760CrossRefPubMed
25.
Zurück zum Zitat Casara D, Rubello D, Piotto A, et al. (99m)Tc-MIBI radio-guided minimally invasive parathyroid surgery planned on the basis of preoperative combined (99m)Tc-pertechnetate/(99m)TC-MIBI and ultrasound imaging protocol. Eur J Nucl Med 2000;27:1300–1304CrossRefPubMed Casara D, Rubello D, Piotto A, et al. (99m)Tc-MIBI radio-guided minimally invasive parathyroid surgery planned on the basis of preoperative combined (99m)Tc-pertechnetate/(99m)TC-MIBI and ultrasound imaging protocol. Eur J Nucl Med 2000;27:1300–1304CrossRefPubMed
26.
Zurück zum Zitat Purcell GP, Dirbas FM, Jeffrey RB, et al. Parathyroid localization with high-resolution ultrasound and technetium Tc99m-sestamibi. Arch Surg 1999;134:824–830CrossRefPubMed Purcell GP, Dirbas FM, Jeffrey RB, et al. Parathyroid localization with high-resolution ultrasound and technetium Tc99m-sestamibi. Arch Surg 1999;134:824–830CrossRefPubMed
27.
Zurück zum Zitat DeLellis RA. Surgical pathology of the parathyroid glands. In Randolph G, editor, Surgery of the Thyroid and Parathyroid Glands, St. Louis, MI, Elsevier, 2003;571–577 DeLellis RA. Surgical pathology of the parathyroid glands. In Randolph G, editor, Surgery of the Thyroid and Parathyroid Glands, St. Louis, MI, Elsevier, 2003;571–577
28.
Zurück zum Zitat Melloul M, Paz A, Koren R, Cytron S, et al. (99m)-TC-MIBI scintigraphy of parathyroid adenomas and its relation to tumour size and oxyphil cell abundance. Eur J Nucl Med 2001;28:209–213CrossRefPubMed Melloul M, Paz A, Koren R, Cytron S, et al. (99m)-TC-MIBI scintigraphy of parathyroid adenomas and its relation to tumour size and oxyphil cell abundance. Eur J Nucl Med 2001;28:209–213CrossRefPubMed
29.
Zurück zum Zitat Carpentier A, Jeannotte S, Verreault J, et al. Preoperative localization of parathyroid lesions in hyperparathyroidism: relationship between technetium 99m-MIBI uptake and oxyphil cell content. J Nucl Med 1998;39(8):1441–1444PubMed Carpentier A, Jeannotte S, Verreault J, et al. Preoperative localization of parathyroid lesions in hyperparathyroidism: relationship between technetium 99m-MIBI uptake and oxyphil cell content. J Nucl Med 1998;39(8):1441–1444PubMed
30.
Zurück zum Zitat Staudenherz A, Abela C, Niederle B, et al. Comparison and histopathological correlation of three parathyroid imaging methods in a population with a high prevalence of concomitant thyroid disease. Eur J Nucl Med 1997;24:143–149PubMed Staudenherz A, Abela C, Niederle B, et al. Comparison and histopathological correlation of three parathyroid imaging methods in a population with a high prevalence of concomitant thyroid disease. Eur J Nucl Med 1997;24:143–149PubMed
31.
Zurück zum Zitat Bhatnagar A, Vezza PR, Bryan JA, et al. Technetium 99m-sestamibi parathyroid scintigraphy: effect of P-glycoprotein, histology and tumour size on detectability. J Nucl Med 1998;39:1617–1620PubMed Bhatnagar A, Vezza PR, Bryan JA, et al. Technetium 99m-sestamibi parathyroid scintigraphy: effect of P-glycoprotein, histology and tumour size on detectability. J Nucl Med 1998;39:1617–1620PubMed
32.
Zurück zum Zitat Ugur O, Bozkurt MF, Hamaloglu E, et al. Clinicopathologic and radiopharmacokinetic factors affecting gamma-probe-guided parathyroidectomy. Arch Surg 2004;139:1175–1179CrossRefPubMed Ugur O, Bozkurt MF, Hamaloglu E, et al. Clinicopathologic and radiopharmacokinetic factors affecting gamma-probe-guided parathyroidectomy. Arch Surg 2004;139:1175–1179CrossRefPubMed
33.
Zurück zum Zitat Westreich RW, Brandwein M, Mechanick JI, et al. Preoperative parathyroid localization: correlating false-negative technetium-99m-sestamibi scans with parathyroid disease. Laryngoscope 2003;113:567–572CrossRefPubMed Westreich RW, Brandwein M, Mechanick JI, et al. Preoperative parathyroid localization: correlating false-negative technetium-99m-sestamibi scans with parathyroid disease. Laryngoscope 2003;113:567–572CrossRefPubMed
34.
Zurück zum Zitat Mehta NY, Ruda JM, Kapadia S, et al. Relationship of technetium-99m sestamibi scans to histopathological features of hyperfunctioning parathyroid tissue. Arch Otol Head Neck Surg 2005;131:493–498CrossRef Mehta NY, Ruda JM, Kapadia S, et al. Relationship of technetium-99m sestamibi scans to histopathological features of hyperfunctioning parathyroid tissue. Arch Otol Head Neck Surg 2005;131:493–498CrossRef
35.
Zurück zum Zitat Flynn MB, Bumpous JM, Schill K, et al. Minimally invasive radioguided parathyroidectomy. J Am Coll Surg 2000;191:24–31CrossRefPubMed Flynn MB, Bumpous JM, Schill K, et al. Minimally invasive radioguided parathyroidectomy. J Am Coll Surg 2000;191:24–31CrossRefPubMed
36.
Zurück zum Zitat Saint Marc O, Cogliandolo A, Pidoto RR, et al. Prospective evaluation of ultrasonography plus MIBI scintigraphy in selecting patients with primary hyperparathyroidism for unilateral neck exploration under local anaesthesia. Am J Surg 2004;187:388–393CrossRefPubMed Saint Marc O, Cogliandolo A, Pidoto RR, et al. Prospective evaluation of ultrasonography plus MIBI scintigraphy in selecting patients with primary hyperparathyroidism for unilateral neck exploration under local anaesthesia. Am J Surg 2004;187:388–393CrossRefPubMed
37.
Zurück zum Zitat Jacobson SR, van Heerden JA, Farley DR, et al. Focused cervical exploration for primary hyperparathyroidism without intraoperative parathyroid hormone monitoring or use of the gamma probe. World J Surg 2004;28:1127–1131CrossRefPubMed Jacobson SR, van Heerden JA, Farley DR, et al. Focused cervical exploration for primary hyperparathyroidism without intraoperative parathyroid hormone monitoring or use of the gamma probe. World J Surg 2004;28:1127–1131CrossRefPubMed
Metadaten
Titel
Negative Imaging Studies for Primary Hyperparathyroidism Are Unavoidable: Correlation of Sestamibi and High-Resolution Ultrasound Scanning with Histological Analysis in 150 Patients
verfasst von
Radu Mihai, MD, PhD, FRCS
Fergus Gleeson, FRCR, FRCP
Ian D. Buley, MA, BM, BCh, FRCPath
Derek E. Roskell, MA, BM, BCh, FRCPath
Gregory P. Sadler, MD, FRCS (Ed), FRCS Gen Surg (Eng)
Publikationsdatum
01.05.2006
Erschienen in
World Journal of Surgery / Ausgabe 5/2006
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-005-0338-9

Weitere Artikel der Ausgabe 5/2006

World Journal of Surgery 5/2006 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.