99MTc-sestamibi as sole technique in selection of primary hyperparathyroidism patients for unilateral neck exploration

Background. Unilateral neck exploration (UNE) is becoming the procedure of choice for treatment of primary hyperparathyroidism (PHPT). The aim, of this study was to evaluate the role, of Tc-99m-sestamibi (MIBI) parathyroid scintigraphy as the sole technique in selecting patients for UNE. Method. We selected 736 consecutive PHPT patients who had only 1 solitary uptake at a MIBI were for UNE. The technique was a single dual-phase using MIBI and a substraction technique with Tc-99m-pertechnetate. Imaging data were correlated with surgical results. Results. In 3 cases, the sestamibi scan was falsely positive, 1 had a cantralateral location relative to the uptake, and 2 had multiglandular hyperplasia. Overall, the positive predictive value (PPV) of MIBI for detecting a solitary parathyroid adenoma in patients with 1 solitary uptake was 97.8. Sixteen patients (12%) had evidence of multinodular goiter. Overall, the PPV of MIBI was 98.4% (2 false positive among 120 cases) in patients with no multinodular thyroid disease (MNG) and 93.7% (1 false negative among 16 cases) in patients with MNG. The mean duration of the surgical procedure was 34.17 minutes. Mean hospitalization. was 0.6 days. Conversion. to bilateral neck exploration was performed in 5 patients. After a period, of follow-up of 40 months (range, 6-72 months), the cure rate was 98%. Conclusion. Patients with, PHPT and unequivocally positive preoperative Tc-99m-sestamibi can safely be managed with UNE without additional localizing techniques.