Single radionuclide scintigraphy with 99mtechnetium-sestamibi and ultrasonography in hyperparathyroidism.

OBJECTIVE: Assessment of 99mTechnetium-sestamibi scintigraphy and ultrasonography as methods of locating enlarged parathyroid glands before operation. DESIGN: Retrospective analysis. SETTING: University hospital, The Netherlands. SUBJECTS: 21 patients with primary hyperparathyroidism and 6 patients with persistent or recurrent hyperparathyroidism. INTERVENTIONS: Single radionuclide scintigraphy with 99mTc-sestamibi, ultrasonography of the neck, and parathyroidectomy. MAIN OUTCOME MEASURES: Operative findings, postoperative serum calcium concentrations. RESULTS: 99mTc-sestamibi scintigraphy correctly identified 17 of 21 parathyroid tumours in patients who were about to undergo their first parathyroidectomy (sensitivity = 81%) with a positive predictive value of 94% and all 6 in patients with persistent or recurrent hyperparathyroidism. Ultrasonography correctly identified 13 parathyroid tumours in 18 patients about to undergo their first parathyroidectomy (sensitivity = 72%) with a positive predictive value of 93%, but only 3 among the 6 patients with persistent or recurrent hyperparathyroidism. CONCLUSION: Single radionuclide scintigraphy with 99mTc-sestamibi seems to identify the sites of parathyroid tumours accurately in patients with persistent or recurrent hyperparathyroidism but is not recommended for patients with primary hyperparathyroidism. Combining scintigraphy with ultrasonography does not improve the accuracy.