Role of 99mTc-sestamibi SPECT in accurate selection of primary hyperparathyroid patients for minimally invasive radio-guided surgery

Abstract

A prerequisite for optimum minimally invasive radio-guided surgery (MIRS) for primary hyperparathyroidism (PHPT) is the demonstration of significant uptake of 99mTc-sestamibi in a parathyroid adenoma (PA). The aim of this study was to evaluate the clinical role or 99mTc-sestamibi SPECT in selecting patients for this procedure. Fifty-four consecutive PHPT patients were evaluated by single-session 99mTc-pertechnetate/99mTc-sestamibi planar subtraction scintigraphy, followed by 99mTc-sestamibi SPECT acquisition to localise hyperfunctioning PAs and assist in planning the surgical approach. Scintigraphy showed the presence of a solitary PA in 47/54 patients (87%) and two or more PAs in four patients (7.4%); it was negative in the remaining three patients (5.6%). The overall sensitivity of 99mTc-sestamibi scintigraphy was 94.6%. In 7/54 patients, the PA was located deep in the para-oesophageal/paratracheal space. So far, 22 patients with scintigraphic evidence of a solitary PA (in four of whom the PA was located deep in the neck) have undergone successful MIRS using the low 37 MBq (1 mCi) 99mTc-sestamibi dose protocol. Intraoperative quick parathyroid hormone (QPTH) assay demonstrated a fall in all 22 patients, thus confirming successful removal of the hyperfunctioning PA. No major surgical complications were observed. After a period of follow-up ranging between 6 and 27 months (median 13 months), no case of persistent/recurrent PHPT was recorded. When comparing the parathyroid to background (P/B) ratio measured at planar and SPECT preoperative scintigraphy with that measured intraoperatively with the gamma probe, a good linear correlation was found between the SPECT and the intraoperative gamma probe measurements (r=0.89; p<0.01) but no correlation was found with planar scintigraphic data. Our preliminary data suggest that measurement of the P/B ratio by means of 99mTc-sestamibi SPECT is more accurate in predicting the intraoperative measurements with the gamma probe. In this respect, a preoperative 99mTc-sestamibi SPECT acquisition should be recommended for better selection of PHPT patients in whom a MIRS approach can be offered.

DOI: 10.1007/s00259-006-0162-y

1 Figure or Table

Statistics

0100200'06'07'08'09'10'11'12'13'14'15'16'17
Citations per Year

97 Citations

Semantic Scholar estimates that this publication has 97 citations based on the available data.

See our FAQ for additional information.

Cite this paper

@article{Rubello2006RoleO9, title={Role of 99mTc-sestamibi SPECT in accurate selection of primary hyperparathyroid patients for minimally invasive radio-guided surgery}, author={Domenico Rubello and Arianna Massaro and Silvia Cittadin and Lucia Rampin and Adil M. Al-Nahhas and Giuseppe Boni and Giuliano Mariani and Maria Rosa Pelizzo}, journal={European Journal of Nuclear Medicine and Molecular Imaging}, year={2006}, volume={33}, pages={1091-1094} }