Comparison of Ultrasonography and 99mTc-sestamibi Scan for Preoperative Localization of Parathyroid Adenoma / 대한내과학회지

ABSTRACT

BACKGROUND/AIMS: Primary hyperparathyroidism can be cured by minimally invasive surgery (MIS) with optimized preoperative localization. Ultrasonography (US) and 99mTc-sestamibi (MIBI) scan are the imaging modalities most widely used for the localization of the affected glands. In this study, we defined the roles of US and MIBI scan. METHODS: We retrospectively reviewed 40 patients who underwent parathyroidectomy for a single parathyroid adenoma between 2004 and 2013. US and scintigraphic findings were compared with operative findings. RESULTS: Adenomas were accurately localized using US and MIBI scan in 38 patients (95%) and 37 patients (92.5%), respectively. Twenty-nine patients (76.3%) showed typical extrathyroidal hypoechoic nodule with central or peripheral vascularity, and, after MIS, we confirmed that they were suffering from a single parathyroid adenoma. Eight patients with atypical US findings and two patients with an undetectable lesion on US underwent MIS after localization using MIBI scan or computed tomography (CT). Only one patient showed an extrathyroidal cystic nodule evidenced by high parathyroid hormone cystic fluid on ultrasound-guided fine-needle aspiration and negative MIBI scan. All lesions not localized on US were located in the superior portion. CONCLUSIONS: US is a sensitive and accurate method for the preoperative localization of parathyroid adenoma, especially if the lesion has typical US features and is located inferiorly. We suggest that US be the first localization modality and that MIBI scan or CT be used in the limited number of cases with negative US findings.