Ultrasound and sestamibi scan as the only preoperative imaging tests in reoperation for parathyroid adenomas

Daniel L. Feingold, H. Richard Alexander, Clara C. Chen, Steven Libutti, Thomas H. Shawker, William F. Simonds, Stephen J. Marx, Monica C. Skarulis, John L. Doppman, David S. Schrump, David L. Bartlett

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Abstract

Background. In an effort to determine an efficient algorithm for the evaluation of patients with parathyroid adenomas in the reoperative setting, we explored the combination of using ultrasound scans (US) and sestamibi scintigraphy as the only preoperative imaging tests. Methods. We analyzed the outcomes of 62 consecutive patients who were treated between January 1995 and May 1999 and who were referred for persistent primary hyperparathyroidism after initial surgical exploration, at which time no abnormal parathyroid glands had been found. Although all patients underwent US, computed tomography scan, magnetic resonance imaging, and sestamibi scan, we analyzed the success of localization and reoperation using only the results of US and sestamibi scan. Results. Sixty-one patients (98%) underwent curative reoperations. The sensitivity, positive predictive value, and accuracy for US were 90%, 86%, and 84%, respectively; the corresponding values for sestamibi imaging were 78%, 94%, and 74%, respectively. In 58 of 62 cases (94%) preoperative US and/or sestamibi scan accurately identified the adenoma. In 3 patients for whom combined US and sestamibi scan were inaccurate, 1 adenoma was found by intraoperative US in the strap muscle; 1 adenoma was found by blind cervical thymectomy, and 1 adenoma was found by planned sternotomy that was based on computed tomography findings. Conclusions. This study supports an algorithm of obtaining US and sestamibi scan as the initial and perhaps only preoperative localization tests for patients with primary hyperparathyroidism after failed operation, at which time no abnormal glands had been found.

Original languageEnglish (US)
Pages (from-to)1103-1110
Number of pages8
JournalSurgery
Volume128
Issue number6
DOIs
StatePublished - Jan 1 2000

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Parathyroid Neoplasms
Reoperation
Adenoma
Primary Hyperparathyroidism
Tomography
Thymectomy
Parathyroid Glands
Sternotomy
Radionuclide Imaging
Magnetic Resonance Imaging
Muscles

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Feingold, D. L., Alexander, H. R., Chen, C. C., Libutti, S., Shawker, T. H., Simonds, W. F., ... Bartlett, D. L. (2000). Ultrasound and sestamibi scan as the only preoperative imaging tests in reoperation for parathyroid adenomas. Surgery, 128(6), 1103-1110. https://doi.org/10.1067/msy.2000.109963
Feingold, Daniel L. ; Alexander, H. Richard ; Chen, Clara C. ; Libutti, Steven ; Shawker, Thomas H. ; Simonds, William F. ; Marx, Stephen J. ; Skarulis, Monica C. ; Doppman, John L. ; Schrump, David S. ; Bartlett, David L. / Ultrasound and sestamibi scan as the only preoperative imaging tests in reoperation for parathyroid adenomas. In: Surgery. 2000 ; Vol. 128, No. 6. pp. 1103-1110.
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abstract = "Background. In an effort to determine an efficient algorithm for the evaluation of patients with parathyroid adenomas in the reoperative setting, we explored the combination of using ultrasound scans (US) and sestamibi scintigraphy as the only preoperative imaging tests. Methods. We analyzed the outcomes of 62 consecutive patients who were treated between January 1995 and May 1999 and who were referred for persistent primary hyperparathyroidism after initial surgical exploration, at which time no abnormal parathyroid glands had been found. Although all patients underwent US, computed tomography scan, magnetic resonance imaging, and sestamibi scan, we analyzed the success of localization and reoperation using only the results of US and sestamibi scan. Results. Sixty-one patients (98{\%}) underwent curative reoperations. The sensitivity, positive predictive value, and accuracy for US were 90{\%}, 86{\%}, and 84{\%}, respectively; the corresponding values for sestamibi imaging were 78{\%}, 94{\%}, and 74{\%}, respectively. In 58 of 62 cases (94{\%}) preoperative US and/or sestamibi scan accurately identified the adenoma. In 3 patients for whom combined US and sestamibi scan were inaccurate, 1 adenoma was found by intraoperative US in the strap muscle; 1 adenoma was found by blind cervical thymectomy, and 1 adenoma was found by planned sternotomy that was based on computed tomography findings. Conclusions. This study supports an algorithm of obtaining US and sestamibi scan as the initial and perhaps only preoperative localization tests for patients with primary hyperparathyroidism after failed operation, at which time no abnormal glands had been found.",
author = "Feingold, {Daniel L.} and Alexander, {H. Richard} and Chen, {Clara C.} and Steven Libutti and Shawker, {Thomas H.} and Simonds, {William F.} and Marx, {Stephen J.} and Skarulis, {Monica C.} and Doppman, {John L.} and Schrump, {David S.} and Bartlett, {David L.}",
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Feingold, DL, Alexander, HR, Chen, CC, Libutti, S, Shawker, TH, Simonds, WF, Marx, SJ, Skarulis, MC, Doppman, JL, Schrump, DS & Bartlett, DL 2000, 'Ultrasound and sestamibi scan as the only preoperative imaging tests in reoperation for parathyroid adenomas', Surgery, vol. 128, no. 6, pp. 1103-1110. https://doi.org/10.1067/msy.2000.109963

Ultrasound and sestamibi scan as the only preoperative imaging tests in reoperation for parathyroid adenomas. / Feingold, Daniel L.; Alexander, H. Richard; Chen, Clara C.; Libutti, Steven; Shawker, Thomas H.; Simonds, William F.; Marx, Stephen J.; Skarulis, Monica C.; Doppman, John L.; Schrump, David S.; Bartlett, David L.

In: Surgery, Vol. 128, No. 6, 01.01.2000, p. 1103-1110.

Research output: Contribution to journalArticle

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T1 - Ultrasound and sestamibi scan as the only preoperative imaging tests in reoperation for parathyroid adenomas

AU - Feingold, Daniel L.

AU - Alexander, H. Richard

AU - Chen, Clara C.

AU - Libutti, Steven

AU - Shawker, Thomas H.

AU - Simonds, William F.

AU - Marx, Stephen J.

AU - Skarulis, Monica C.

AU - Doppman, John L.

AU - Schrump, David S.

AU - Bartlett, David L.

PY - 2000/1/1

Y1 - 2000/1/1

N2 - Background. In an effort to determine an efficient algorithm for the evaluation of patients with parathyroid adenomas in the reoperative setting, we explored the combination of using ultrasound scans (US) and sestamibi scintigraphy as the only preoperative imaging tests. Methods. We analyzed the outcomes of 62 consecutive patients who were treated between January 1995 and May 1999 and who were referred for persistent primary hyperparathyroidism after initial surgical exploration, at which time no abnormal parathyroid glands had been found. Although all patients underwent US, computed tomography scan, magnetic resonance imaging, and sestamibi scan, we analyzed the success of localization and reoperation using only the results of US and sestamibi scan. Results. Sixty-one patients (98%) underwent curative reoperations. The sensitivity, positive predictive value, and accuracy for US were 90%, 86%, and 84%, respectively; the corresponding values for sestamibi imaging were 78%, 94%, and 74%, respectively. In 58 of 62 cases (94%) preoperative US and/or sestamibi scan accurately identified the adenoma. In 3 patients for whom combined US and sestamibi scan were inaccurate, 1 adenoma was found by intraoperative US in the strap muscle; 1 adenoma was found by blind cervical thymectomy, and 1 adenoma was found by planned sternotomy that was based on computed tomography findings. Conclusions. This study supports an algorithm of obtaining US and sestamibi scan as the initial and perhaps only preoperative localization tests for patients with primary hyperparathyroidism after failed operation, at which time no abnormal glands had been found.

AB - Background. In an effort to determine an efficient algorithm for the evaluation of patients with parathyroid adenomas in the reoperative setting, we explored the combination of using ultrasound scans (US) and sestamibi scintigraphy as the only preoperative imaging tests. Methods. We analyzed the outcomes of 62 consecutive patients who were treated between January 1995 and May 1999 and who were referred for persistent primary hyperparathyroidism after initial surgical exploration, at which time no abnormal parathyroid glands had been found. Although all patients underwent US, computed tomography scan, magnetic resonance imaging, and sestamibi scan, we analyzed the success of localization and reoperation using only the results of US and sestamibi scan. Results. Sixty-one patients (98%) underwent curative reoperations. The sensitivity, positive predictive value, and accuracy for US were 90%, 86%, and 84%, respectively; the corresponding values for sestamibi imaging were 78%, 94%, and 74%, respectively. In 58 of 62 cases (94%) preoperative US and/or sestamibi scan accurately identified the adenoma. In 3 patients for whom combined US and sestamibi scan were inaccurate, 1 adenoma was found by intraoperative US in the strap muscle; 1 adenoma was found by blind cervical thymectomy, and 1 adenoma was found by planned sternotomy that was based on computed tomography findings. Conclusions. This study supports an algorithm of obtaining US and sestamibi scan as the initial and perhaps only preoperative localization tests for patients with primary hyperparathyroidism after failed operation, at which time no abnormal glands had been found.

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