The American Journal of Surgery
Volume 199, Issue 5 , Pages 614-620, May 2010

Determinants of Tc-99m sestamibi SPECT scan sensitivity in primary hyperparathyroidism

  • Todd W. Swanson, M.D.

      Affiliations

    • Department of Surgery, St Paul's Hospital & University of British Columbia, Vancouver, BC, Canada
    • ,
  • Simon K. Chan, M.S.

      Affiliations

    • Department of Medical Genetics, University of British Columbia, British Columbia Cancer Agency and Michael Smith Genome Sciences Center, Vancouver, BC, Canada
    • ,
  • Steven J. Jones, Ph.D.

      Affiliations

    • Department of Medical Genetics, University of British Columbia, British Columbia Cancer Agency and Michael Smith Genome Sciences Center, Vancouver, BC, Canada
    • ,
  • Samuel Bugis, M.D., F.R.C.S.C.

      Affiliations

    • Department of Surgery, St Paul's Hospital & University of British Columbia, Vancouver, BC, Canada
    • ,
  • Robert Irvine, M.D., F.R.C.S.C.

      Affiliations

    • Department of Surgery, St Paul's Hospital & University of British Columbia, Vancouver, BC, Canada
    • ,
  • Allan Belzberg, M.D., F.R.C.P.C.

      Affiliations

    • Department of Nuclear Medicine, St Paul's Hospital & University of British Columbia, Vancouver, BC, Canada
    • ,
  • Daniel Levine, M.B.Ch.B., M.R.C.P., F.R.C.R., F.R.C.P.C.

      Affiliations

    • Department of Nuclear Medicine, St Paul's Hospital & University of British Columbia, Vancouver, BC, Canada
    • ,
  • Sam M. Wiseman, M.D., F.R.C.S.C.

      Affiliations

    • Department of Surgery, St Paul's Hospital & University of British Columbia, Vancouver, BC, Canada
    • Corresponding Author InformationCorresponding author. Tel.: 604-806-9108; fax: 604-806-9957

Received 3 November 2009; received in revised form 4 February 2010

Abstract 

Background

The aim of this study was to evaluate the influence of patient and adenoma characteristics on 99mTc–methoxy isobutyl isonitrile (MIBI) scan performance in individuals diagnosed with primary hyperparathyroidism (PHP).

Methods

Records of patients undergoing parathyroidectomy for PHP over 6 years at a single center were reviewed.

Results

The overall true-positive (TP) rate for 99mTc-MIBI scans was 56%. Adenomas sized 1.9 to 3.5 cm were more likely to have TP scans than 0.3-cm to 1.8-cm adenomas (74% vs 40%, P < .001). Preoperative ionized calcium levels between 1.49 and 1.72 mmol/L were more likely to have TPs than levels between 1.27 and 1.48 mmol/L (65% vs 47%, P < .05). No single class of medication was shown to significantly effect TP rates. A decrease in TP rate was observed for larger adenomas in patients on ≥1 medication (74% vs 65%, P = .05).

Conclusions

In PHP, 99mTc-MIBI scan positivity is most related to adenoma size and preoperative ionized calcium level.

Keywords: Primary hyperparathyroidism, Sestamibi scan, Parathyroid surgery

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 This work was supported by the Michael Smith Foundation for Health Research (Vancouver, BC, Canada). Dr Wiseman is a Michael Smith Foundation for Health Research Scholar.

PII: S0002-9610(10)00051-6

doi:10.1016/j.amjsurg.2010.02.001

The American Journal of Surgery
Volume 199, Issue 5 , Pages 614-620, May 2010

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