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Erschienen in:
01.10.2011 | Endocrine Tumors
What is the Added Benefit of Cervical Ultrasound to 99mTc-Sestamibi Scanning in Primary Hyperparathyroidism?
Erschienen in: Annals of Surgical Oncology | Ausgabe 10/2011
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Background
Minimally invasive parathyroidectomy for primary hyperparathyroidism depends on accurate preoperative imaging, which is traditionally accomplished by 99mTc-sestamibi scanning. Cervical ultrasound is gaining in use, but it is unclear how much information it adds to the routine use of 99mTc-sestamibi scans.
Methods
A prospectively maintained database of patients undergoing parathyroidectomy for primary hyperparathyroidism was queried, and the utility of cervical ultrasound in preoperative planning was analyzed.
Results
Between July 2002 and November 2009, 310 patients with primary hyperparathyroidism underwent both 99mTc-sestamibi and ultrasound imaging. Ultrasound added new information to 99mTc-sestamibi in 43 patients (14%) by finding either the correct enlarged gland (n = 40, 88%) or additional enlarged glands (n = 5, 12%). Ultrasound correctly localized glands in 38 of 85 (45%) patients with a negative 99mTc-sestamibi, allowing for a minimally invasive parathyroidectomy in those patients. However, in the 206 patients (66%) who had a 1-gland positive 99mTc-sestamibi, ultrasound only added information for 8 patients (4%). When compared with radiology-performed ultrasound, surgeon-performed ultrasound was successful in localizing additional glands in 27 (15%) versus 17 patients (10%) (P < 0.001).
Conclusions
Ultrasound led to additional localization information in 14% of patients, although this benefit was less in patients with a clearly positive 1-gland 99mTc-sestamibi scan. Cervical ultrasound provides added benefit to 99mTc-sestamibi scanning in patients with primary hyperparathyroidism, but its greatest utility is when performed by a surgeon in patients with a negative 99mTc-sestamibi scan.