Diagnostic value of Sestamibi Scan in the preoperative localization of parathyroid lesions in patients with primary hyperparathyroidism.

Abstract

Abstract Introduction: Preoperative localization modalities for patients with primary hyperparathyroidism today play an important role in clinical decision making, surgical procedure, and the prognosis of patients. One of the most common preoperative imaging modalities is the sestamibi scan labeled with Technetium-99m, which is capable of determining the location of parathyroid lesions in primary hyperparathyroidism patients with high sensitivity. Methods: In this cross-sectional study, 25 patients with primary hyperparathyroidism, referred to endocrine clinic of Tabriz University of Medical Siences during 2016-2018 were enrolled. All patients underwent a preoperative Sestamibi scan. Comparing the results of the scan with the surgical findings as a standard gold method for diagnosis, the diagnostic value of the scan was evaluated for the localization of parathyroid lesions. Results: According to the items observed in surgery and pathologic findings, the sensitivity of Sestamibi scan for the localization of parathyroid lesions was 84.6%. Specificity and positive predictive value and negative predictive value were 95.6%, 89.6%, and 94.8%, respectively. A significant relationship was observed between the type of lesion and the sensitivity of Sestamibi scan (p=0.002). Conclusion: Sestamibi scan has high sensitivity and diagnostic and therapeutic value for patients with primary hyperparathyroidism. However, the existence of other pre- and intraoperative localization modalities, at the request of surgeons, is useful and warranted to reduce the rate of recurrent surgery as well as to minimize false negatives.

Keywords: Hyperparathyroidism, Tc-99m-MIBI scintigraphy, localization, adenoma, hyperplasia