Sestamibi scanning and outcomes in minimally invasive parathyroidectomy

To determine whether preoperative sestamibi scanning facilitates the desired outcome of successful completion of minimally invasive parathyroidectomy (MIP) and also to analyze the results in patients with underlying concurrent thyroid disease.

We undertook a retrospective analysis by review of medical records of 133 parathyroidectomies for sporadic primary hyperparathyroidism with preoperative sestamibi scanning during a 26-month period at our medical center.

Of the 133 patients with preoperative sestamibi scanning, 106 were candidates for MIP, and 86 had positive scans showing a localized focus of uptake. MIP, with use of intraoperative parathyroid hormone level monitoring, was successfully completed in 70 patients; the other 16 patients required conversion to bilateral neck exploration. Another 20 patients with negative sestamibi scans (no localized focus of uptake) also underwent MIP. The surgeon used ultrasonography or subtle, nondiscrete sestamibi scan findings to decide on this approach. In this group, 65% of patients had successful completion of MIP, in comparison with 81% (95% confidence interval, 72% to 89%) in the group with positive scans (P = 0.13). Subgroup analysis of patients with underlying concomitant thyroid abnormalities showed successful completion of MIP in 39 of 51 (76%), in comparison with 31 of 35 patients (89%) without thyroid abnormalities (P = 0.16).

In patients with sporadic primary hyperparathyroidism, finding a localized focus of uptake on a preoperative sestamibi scan facilitates successful completion of MIP. In patients with underlying thyroid disease, positive sestamibi scans are still useful in completing MIP, but more patients in this group require conversion to bilateral neck dissection.