ESA-SRB-AOTA 2019

Correlation of pre-operative sestamibi scintigraphy with operative findings in primary hyperparathyroidism (#504)

Lauren Burrage 1 , Shyam Sunder 1 , Michael Donovan 2
  1. Department of Endocrinology and Diabetes, Sunshine Coast Health Service, Sunshine Coast, Queensland, Australia
  2. Department of Surgery, Sunshine Coast Health Service, Sunshine Coast, Queensland, Australia

Background: Minimally invasive parathyroidectomy is an appealing option for treatment of primary hyperparathyroidism (1). Good quality pre-operative localisation imaging is essential to facilitate the surgical approach. Several imaging modalities are available, however there are advantages and disadvantages to each. The literature reports a wide range of accuracies for each modality (2, 3, 4). The purpose of this study was to define the accuracy and positive predictive value (PPV) of Sestamibi scintigraphy for pre-operative localisation in primary hyperparathyroidism in a cohort of patients from a large regional hospital that includes parathyroid adenoma and hyperplasia. Furthermore, we aimed to evaluate the role of inter-observer variation in interpretation of Sestamibi scintigraphy.

Method: A retrospective chart review was conducted on all parathyroid surgeries completed at Nambour General Hospital from January 2010 to February 2017. There was a total of 140 patients. 117 patients met inclusion criteria. Sestamibi reports were reviewed and recorded as correlating with the correct side or quadrant as compared with operative and histopathologic findings.

Results: 103 patients (88%) had adenomas and 14 patients (12%) had parathyroid hyperplasia. Sestamibi scans had an accuracy of 60% and PPV of 71% for localising the correct quadrant and  accuracy of 73% and PPV of 87% for localising the correct side. However, 76% of negative Sestamibi scans had an adenoma subsequently confirmed at operation. There were 12 imaging providers in total. Accuracy and PPV were calculated for the 4 major providers. Using the Marascuillo method, there was no significant difference in accuracies or PPV between imaging providers (P<0.05).

Conclusion: The accuracy of Sestamibi scintigraphy for pre-operative localisation in our cohort of patients is similar to literature reports. The low accuracy of negative scans suggests that additional imaging (including 4D-computed tomography or high resolution ultrasonography) should be performed to reduce the need for bilateral (classical) neck exploration.

  1. Udelsman R, Lin Z, Donovan P. The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism. Ann Surg. 2011, 253(3):585-591.
  2. Kunstan J, Kirsch J, Mahajan A et al. Parathyroid localisation and implications for clinical management. J Clin Endocrinol Metab. 2013,98(3): 902-912.
  3. Cheung K, Wang T, Farrokhyar F et al. A meta-analysis of preoperative localisation techniques for patients with primary hyperparathyroidism. Ann Surg Oncol. 2012, 19(2):577-583.
  4. Liddy S, Worsley D, Torreggiani W et al. Preoperative imaging in primary hyperparathyroidism: literature review and recommendations. Can Assoc Radiol J. 2017, 68(1):47-55.