Clinical surgery–International
The positive effect of adenoma weight and oxyphil cell content on preoperative localization with 99mTc-sestamibi scanning for primary hyperparathyroidism

https://doi.org/10.1016/j.amjsurg.2007.01.040Get rights and content

Abstract

Background

Although the sensitivity of sestamibi scanning (MIBI) is high in patients with solitary parathyroid adenomas, negative sestamibi scan results are inevitable. The exact mechanism of visualization of abnormal and hyperfunctioning parathyroid tissue is not yet clear. The aims of this clinical study were (1) to evaluate positive and negative sestamibi scan results with regard to adenoma weight and oxyphil cell content and (2) to compare the effects of adenoma weight and oxyphil cell content on the results of sestamibi scanning.

Patients

The patients were divided in 2 groups according to their sestamibi scan results. Group 1 consisted of 27 patients with positive sestamibi scan results, and group 2 consisted of 20 patients with negative sestamibi scan results. Parathyroid adenoma weight and oxyphil cell content were determined in all patients.

Results

The weight and oxyphil cell content of the parathyroid adenomas in the patients of group 1 were significantly higher than those in the patients of group 2 (P = .001). An adenoma weight >600 mg and an oxyphil cell content >20% increased the rate of obtaining a positive sestamibi scan result 10- and 4-fold, respectively.

Conclusions

Both adenoma weight and oxyphil cell content were found to significantly correlate with positive sestamibi scan results. In patients with high-weight adenomas, adenoma weight was the most significant factor in obtaining positive MIBI scan results, whereas in patients with low adenoma weights, high oxyphil cell content was the most significant factor in obtaining positive MIBI scan results.

Section snippets

Patients

We performed a retrospective study of 70 consecutive patients with pHPT who underwent parathyroidectomy in the Department of General Surgery at the Istanbul Medical Faculty from 2004 to 2006. The data from 47 patients were analyzed. The remaining 23 patients were excluded because of sestamibi scanning performed at another institution, secondary or tertiary HPT, or multiple endocrine neoplasias, false-positive scan results, incomplete data, or inability to retrieve archived pathology specimens

Patients

Mean age of both groups together was 51 ± 12 years (range 23–77). The female-to-male ratio was 8.4:1 (n = 42 women and 5 men). Mean serum calcium and PTH levels were 12.4 ± .9 mg/dL and 370.85 ± 250 pg/dL, respectively. Mean adenoma weight and oxyphil cell contents were 1,189 ± 1,515 mg (range 132–10,000) and 19% ± 21% (range 1%–80%), respectively. In some cases, oxyphil cells were randomly distributed among chief cells, whereas in others they formed clusters. When they formed clusters, they

Comments

We compared the effects of adenoma weight and oxyphil cell content on sestamibi scan results. Adenoma weight >600 mg and oxyphil cell content >20% were found to be independent factors influencing positive sestamibi scan results. However, in patients with parathyroid adenomas having oxyphil cell contents >20%, positive sestamibi scan results were achieved despite low-weight adenomas. Patients with higher-weight adenomas had positive sestamibi scan results regardless of oxyphil cell content. As

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