Sestamibi scan in renal parathyroidectomy: a worthwhile preoperative exam?

Area of Science:

• Nephrology
• Endocrinology
• Surgical Oncology

Background:

• Surgical treatment for hyperparathyroidism in chronic kidney disease patients presents significant challenges within Brazil's public healthcare system.
• High medication costs and lengthy waiting times for preoperative imaging, particularly technetium Tc 99m Sestamibi (MIBI) scans, contribute to these difficulties.
• Physicians often hesitate to proceed with surgery without localization imaging, despite its questionable utility in this context.

Purpose of the Study:

• To assess the effectiveness of surgical intervention for renal hyperparathyroidism when preoperative MIBI scans are omitted.
• To evaluate the feasibility and success rates of parathyroidectomy in patients with chronic kidney disease-related hyperparathyroidism without relying on preoperative localization.

Main Methods:

• A cohort of 114 patients with renal hyperparathyroidism underwent surgical treatment.
• Procedures included total parathyroidectomy with autotransplantation and subtotal parathyroidectomy.
• Crucially, all surgeries were performed without the use of preoperative MIBI scans.

Main Results:

• The study included 37 patients with secondary hyperparathyroidism on dialysis and 77 with persistent disease post-renal transplant.
• A high success rate of 93.8% (107 out of 114 patients) was achieved.
• Failures (7 cases) were attributed to difficulty locating glands (1-2 glands missed in 6 cases) or a postoperative diagnosis of a supernumerary gland in one case.

Conclusions:

• Surgical treatment for renal hyperparathyroidism is a highly effective and reproducible procedure, achieving a 93.8% success rate even when preoperative MIBI scans are not utilized.
• This approach offers a viable solution to overcome challenges associated with preoperative imaging costs and wait times in public healthcare systems.
• The findings support the consideration of parathyroidectomy without MIBI localization for selected patients with renal hyperparathyroidism.