Arzu BİLEN, Habib BİLEN, Korhan KILIÇ, Muhammed Sedat SAKAT, Furkan ŞENGÖZ, Abdulkadir ŞAHİN, Bülent AKTAN

Diagnostic value of ultrasonograpy and 99mTc-MIBIscintigraphy for preoperative localization of parathyroidadenomas

Aim: The primary treatment of primary hyperparathyroidism (PHPT) is parathyroidectomy. With its shorter operative time and healing period, lesser general anesthesia duration, lesser hypoparathyroidism risk and better cosmetic results minimally invasive parathyroidectomy is the most commonly performed contemporary surgical procedure. However, in order for this procedure to be successful, it is important to know the location of the parathyroid adenoma. The purpose of this study was to determine the diagnostic value of Ultrasonography (USG) and technetium methoxyisobutylisonitrile scintigraphy (99mTc-MIBI) in the preoperative localization of parathyroid adenoma.Materials and Methods: Fifty-two patients diagnosed with parathyroid adenoma were included in the study. Preoperative parathyroid USG and 99mTc-MIBI were performed on all patients. All patients’ preoperative serum calcium, phosphorus, parathormone and Vitamin D levels, parathyroid USG and 99mTc-MIBI, intraoperative parathyroid lesion location and histopathological examination results were recorded. Results: Patients aged between 22 and 81 (51.7±15.6) were eventually enrolled. When USG was used alone, the site of the adenoma was correctly determined in 26 of the 52 patients with a sensitivity of 52% and a positive predictive value of 92.8%. When scintigraphy was performed alone, the site of the adenoma was correctly identified in 39 of the 52 patients. Sensitivity was thus 76.4% and positive predictive value 97.5%. When USG and scintigraphy were assessed together, adenoma location was correctly identified in 45 of the 52 patients. Sensitivity for the two tests employed together was 88.2% and positive predictive value was 97.8%. Conclusions: Due to the high sensitivity of combined use of USG and 99mTc-MIBI, we recommend the two tests to be assessed together before parathyroid surgery.

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1. Huang Z, Lou C. (99m)TcO(4)(-)/(99m)Tc-MIBI dualtracer scintigraphy for preoperative localization of parathyroid adenomas. J Int Med Res 2019;47:836- 45.
2. Gungor A, Bilen H, Akbas EM, et al. Hyperparathyroidism in pregnancy: Report of two cases. Dicle Tip Dergisi 2013;40:501.
3. Ghilardi G, De Pasquale L. Hungry bone syndrome after parathyroidectomy for primary hyperthyroidism. Ghilardi and De Pasquale, Surgery Curr Res 2014;4:2.
4. Sosa JA, Powe NR, Levine MA, et al. Profile of a clinical practice: thresholds for surgery and surgical outcomes for patients with primary hyperparathyroidism: a national survey of endocrine surgeons. J Clin Endocrinol Metab 1998;83:2658-65.
5. Krčálová E, Horáček J, Nováková E, et al. Dual Tracer 99mTc-Pertechnetate/99mTc-MIBI Dual-TimePoint SPECT/CT Parathyroid Gland Assessment Regarding to Parathyroid Gland Size and Biochemical Parameters–Two Years Single Imaging Centre Experience. Acta Medica (Hradec Králové) 2019;62:1- 5.
6. Moghadam RN, Amlelshahbaz AP, Namiranian N, et al. Comparative diagnostic performance of ultrasonography and 99mTc-sestamibi scintigraphy for parathyroid adenoma in primary hyperparathyroidism; systematic review and metaanalysis. Asian Pacific journal of cancer prevention: APJCP 2017;18:3195.
7. Bilezikian JP, Brandi ML, Eastell R, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. The Journal of Clinical Endocrinology & Metabolism 2014;99:3561-9.
8. George EF, Komisar A, Scharf SC, et al. Diagnostic value of the preoperative sestamibi scan in intraoperative localization of parathyroid adenomas: a case study. The Laryngoscope 1998;108:627-9.
9. Denham DW, James Norman M. 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;186:293-305.
10. Ersoy R, Ersoy O, Ogmen BE, et al. Diagnostic value of endoscopic ultrasonography for preoperative localization of parathyroid adenomas. Endocrine 2014;47:221-6.
11. Shen W, Sabanci U, Morita ET, et al. Sestamibi scanning is inadequate for directing unilateral neck exploration for first-time parathyroidectomy. Archives of Surgery 1997;132:969-76.
12. Lowney JK, Weber B, Johnson S, et al. Minimal incision parathyroidectomy: cure, cosmesis, and cost. World J Surg 2000;24:1442-5.
13. Stanciu M, Boicean LC, Popa FL. The role of combined techniques of scintigraphy and SPECT/CT in the diagnosis of primary hyperparathyroidism: A case report. Medicine 2019;98.
14. Huppert BJ, Reading CC. Parathyroid sonography: imaging and intervention. J Clin Ultrasound 2007;35:144-55.
15. Ozdemir D, Arpaci D, Ucler R, et al. Parathyroid incidentalomas detected during thyroid ultrasonography and effect of chronic thyroiditis on false positive parathyroid lesions. Endocrine 2012;42:616-21.
16. Akbaba G, Berker D, Isik S, et al. A comparative study of pre-operative imaging methods in patients with primary hyperparathyroidism: Ultrasonography, 99m Tc sestamibi, single photon emission computed tomography, and magnetic resonance imaging. J Endocrinol Invest 2012;35:359-64.
17. Tublin ME, Pryma DA, Yim JH, et al. Localization of parathyroid adenomas by sonography and technetium tc 99m sestamibi single-photon emission computed tomography before minimally invasive parathyroidectomy: are both studies really needed? J Ultrasound Med 2009;28:183-90.
18. Lorberboym M, Minski I, Macadziob S, et al. Incremental diagnostic value of preoperative 99mTcMIBI SPECT in patients with a parathyroid adenoma. J Nucl Med 2003;44:904-8.