TY - JOUR
T1 - The efficacy of sestamibi parathyroid scintigraphy for directing surgical approaches based on modified interpretation criteria
AU - Kim, Chun K.
AU - Kim, Suzy
AU - Krynyckyi, Borys R.
AU - Machac, Josef
AU - Inabnet, William B.
PY - 2002
Y1 - 2002
N2 - Purpose: With the increasing use of targeted parathyroidectomy, the accuracy of sestamibi parathyroid scintigraphy (SPS) in determining the best surgical approach has become more clinically relevant than its sensitivity for detecting all abnormal glands. The reported accuracy of SPS does not represent the true efficacy of SPS for directing targeted parathyroidectomy, because many authors reported accuracy on the basis of abnormal glands. The authors assessed the efficacy of SPS based on modified interpretation criteria to determine specifically whether SPS influences the surgeon's choice of a targeted versus a conventional approach to parathyroidectomy. Methods: The authors reviewed the SPS studies (both dual-isotope subtraction and Tc-99m sestamibi dual-phase techniques) performed in 80 patients with primary hyperparathyroidism. All patients had surgery with histologic diagnoses, intraoperative PTH assays, and clinical follow-up. Results: Of 75 patients with solitary adenomas, 9 SPS studies were negative, equivocal, or showed two or more foci, and 66 studies showed a solitary focus on the correct side. Of these 66 studies, 63 showed a lesion in the correct quadrant (e.g., superior or inferior) and 3 predicted the correct side only but a wrong quadrant. The positive-predictive value of SPS was 100% for correctly identifying the side of the adenoma (thus correctly directing unilateral surgery) and 95.5% for correctly identifying the quadrant of the solitary adenoma. Conclusion: The positive-predictive value of SPS for directing the surgical approach (but not for detecting individual lesions) that reveals a single focus is very high based on our modified interpretation criteria.
AB - Purpose: With the increasing use of targeted parathyroidectomy, the accuracy of sestamibi parathyroid scintigraphy (SPS) in determining the best surgical approach has become more clinically relevant than its sensitivity for detecting all abnormal glands. The reported accuracy of SPS does not represent the true efficacy of SPS for directing targeted parathyroidectomy, because many authors reported accuracy on the basis of abnormal glands. The authors assessed the efficacy of SPS based on modified interpretation criteria to determine specifically whether SPS influences the surgeon's choice of a targeted versus a conventional approach to parathyroidectomy. Methods: The authors reviewed the SPS studies (both dual-isotope subtraction and Tc-99m sestamibi dual-phase techniques) performed in 80 patients with primary hyperparathyroidism. All patients had surgery with histologic diagnoses, intraoperative PTH assays, and clinical follow-up. Results: Of 75 patients with solitary adenomas, 9 SPS studies were negative, equivocal, or showed two or more foci, and 66 studies showed a solitary focus on the correct side. Of these 66 studies, 63 showed a lesion in the correct quadrant (e.g., superior or inferior) and 3 predicted the correct side only but a wrong quadrant. The positive-predictive value of SPS was 100% for correctly identifying the side of the adenoma (thus correctly directing unilateral surgery) and 95.5% for correctly identifying the quadrant of the solitary adenoma. Conclusion: The positive-predictive value of SPS for directing the surgical approach (but not for detecting individual lesions) that reveals a single focus is very high based on our modified interpretation criteria.
KW - MIBI
KW - Parathyroid Adenoma
KW - Parathyroid Gland
KW - Sestamibi
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U2 - 10.1097/00003072-200204000-00002
DO - 10.1097/00003072-200204000-00002
M3 - Article
C2 - 11914662
AN - SCOPUS:0036129973
SN - 0363-9762
VL - 27
SP - 246
EP - 248
JO - Clinical Nuclear Medicine
JF - Clinical Nuclear Medicine
IS - 4
ER -