RESUMO
BACKGROUND: The primary benefit of preoperative scintigraphy in patients with primary hyperparathyroidism not previously surgically explored seems to be the possibility of unilateral or limited access surgery in selected patients. MATERIAL AND METHODS: We studied the accuracy of scintigraphy using 99mTc sestamibi and dual phase imaging protocol combined with thyroid scintigraphy using 99mTc pertechnetate before conventional neck exploration and histologic verification in 78 consecutive patients. RESULTS: In 65 patients with solitary, focal uptake on scintigraphy, we found a solitary adenoma in 61 patients (94%), a solitary adenoma on the contralateral side in one patient, two adenomas on the indicated side in one patient, bilateral adenomas in one and hyperplasia in one patient. In 13 patients with a negative or equivocal scintigraphic result, eight had a solitary adenoma and five hyperplasia. INTERPRETATION: These result may support a limited unilateral surgical approach when scintigraphy shows a localized focal uptake and this is confirmed perioperatively. In experienced hands the risk of overlooking an adenoma will be small. However, it is mandatory to have an experienced parathyroid surgeon prepared to proceed with full neck exploration when this is necessary.
