Parathyroid disease diagnosis: A look at scintigraphy, ultrasound, and lab tests

The primary aim of this study is to assess how well ultrasonography and 99mTc-sestamibi scintigraphy perform as diagnostic tools for hyperparathyroidism (HPT) when compared to the clinical measurements of parathyroid hormone (PTH) levels. This evaluation is intended to help formulate the most effective preoperative plan and guide clinical decision-making. A retrospective study of 350 HPT cases in King Abdul-Aziz University Hospital over a period spanning 2012 to 2023 was carried out. Sensitivity, specificity, and receiver operator characteristic curve AUC were used to determine the diagnostic performance of ultrasonography, 99mTc-sestamibi scintigraphy, and combined imaging to the standard of biochemical PTH levels. The statistical tests involved the McNemar test and logistic regression to evaluate the predictors such as chronic kidney disease (CKD). The combined imaging demonstrated diagnostic accuracy of 0.69 compared to 0.74 and 0.64 of scintigraphy and ultrasonography respectively. The scintigraphy had a total of 161 true positives and 73 false negative results whereas ultrasonography had a total of 139 true positives and 95 false negative results. CKD was also a good determinant in HPT (odds ratio = 1.988, p = 0.026). According to the McNemar test, there was no significant difference between ultrasonography and scintigraphy (p = 0.494). The diagnostic inaccuracy of ultrasonography is lower in diagnosing HPT as compared to scintigraphy, however using combined imaging may provide more reliability in diagnosis hence it can be used in preoperative planning, especially in patients with CKD.