Minimally invasive parathyroidectomy and preoperative MIBI scans: correlation of gland weight and preoperative PTH

Daniel Calva-Cerqueira; Brian J Smith; Michelle L Hostetler; Geeta Lal; Yusuf Menda; Thomas M O'Dorisio; James R Howe

doi:10.1016/j.jamcollsurg.2007.06.322

Journal article

Minimally invasive parathyroidectomy and preoperative MIBI scans: correlation of gland weight and preoperative PTH

Daniel Calva-Cerqueira, Brian J Smith, Michelle L Hostetler, Geeta Lal, Yusuf Menda, Thomas M O'Dorisio and James R Howe

Journal of the American College of Surgeons, Vol.205(4 Suppl), pp.S38-S44

10/2007

DOI: 10.1016/j.jamcollsurg.2007.06.322

PMID: 17916517

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Abstract

Minimally invasive parathyroidectomy (MIP) has become increasingly popular for the treatment of patients with primary hyperparathyroidism (pHPT), and the specific techniques used vary from surgeon to surgeon. This strategy depends on preoperative localization tests, of which the MIBI scan is the most commonly used. This study details one surgeon's MIP experience and examines factors that correlate with the results of sestamibi (MIBI) scans. A retrospective review of parathyroidectomies performed between 1996-2006 was performed to create a database including laboratory and imaging results, symptoms, length of stay, and complications. MIBI scans were classified as correct when they showed one area of uptake at the site of a single adenoma (SA) found at exploration. Correlation between patient factors and MIBI scan results were assessed with Spearman correlation and Wilcoxon rank-sum tests. Of 263 patients having parathyroidectomy for pHPT, 205 had SA, 40 double adenomas, 15 hyperplasia, and 3 negative explorations. Normocalcemia was achieved in 98% of patients at 1 year and 95% by intraoperative parathyroid hormone (PTH) criteria. Factors that were significantly correlated with MIBI scan results in SA patients were preoperative PTH (p = 0.0025) and adenoma weight (p < 0.0001). The median PTH in those with correct scans was 137 versus 101 pg/mL in those with incorrect scans, and the median adenoma weights were 920 and 280 mg, respectively. The MIBI scan is a good localization test that made unilateral exploration and MIP possible in 76% of the cases. MIBI scans are more likely to be correct with higher preoperative PTH and larger adenomas.

Adenoma - diagnosis

Adenoma - surgery

Parathyroid Neoplasms - complications

Humans

Organ Size

Hyperparathyroidism, Primary - diagnostic imaging

Male

Parathyroid Hormone - blood

Parathyroid Neoplasms - diagnosis

Parathyroid Neoplasms - surgery

Parathyroidectomy

Preoperative Care

Adenoma - complications

Parathyroid Glands - surgery

Hyperparathyroidism, Primary - pathology

Radionuclide Imaging

Female

Retrospective Studies

Technetium Tc 99m Sestamibi

Radiopharmaceuticals

Parathyroid Glands - pathology

Hyperparathyroidism, Primary - surgery

Minimally Invasive Surgical Procedures

Details

Title: Subtitle: Minimally invasive parathyroidectomy and preoperative MIBI scans: correlation of gland weight and preoperative PTH
Creators: Daniel Calva-Cerqueira - Department of Surgery, University of Iowa Carver College of Medicine, IA, USA
Brian J Smith
Michelle L Hostetler
Geeta Lal
Yusuf Menda
Thomas M O'Dorisio
James R Howe
Resource Type: Journal article
Publication Details: Journal of the American College of Surgeons, Vol.205(4 Suppl), pp.S38-S44
Publisher: United States
DOI: 10.1016/j.jamcollsurg.2007.06.322
PMID: 17916517
ISSN: 1072-7515
eISSN: 1879-1190
Language: English
Date published: 10/2007
Academic Unit: Radiology; Biostatistics; Surgery; Radiation Oncology; Holden Comprehensive Cancer Center; Internal Medicine
Record Identifier: 9983997440602771

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