Minimally Invasive/Focused Parathyroidectomy in Patients With Negative Sestamibi Scan Results

Objective: To examine the feasibility of minimally invasive/focused parathyroidectomy in patients with primary hyperparathyroidism and negative results on pre-operative sestamibi scanning. Design: Retrospective review. Setting: Hospital. Patients: A total of 452 patients with primary hyperparathyroidism underwent parathyroidectomy between January 2005 and December 2009. Main Outcome Measures: Preoperative sestamibi scans were reviewed, and their influence on the surgical outcome was examined. Records of the intraoperative and postoperative findings were also reviewed. Results: Seventy-seven patients (17.0%) were found to have negative results on preoperative sestamibi scans, and these patients formed our cohort study group. In this group, neck ultrasonography performed as an adjunct was able to preoperatively localize an area that was suggestive of a single adenoma in 61 patients (79.2%), 53 of whom were confirmed to have a single adenoma intra-operatively (sensitivity, 80.3%; specificity, 27.3%; positive predictive value, 86.9%; and negative predictive value, 18.8%). In total, 66 of 77 patients (85.7%) were confirmed to have a single adenoma at the time of surgery. Conclusions: Negative results on sestamibi scans should not be used as exclusion criteria for minimally invasive/focused parathyroidectomy in patients with primary hyperparathyroidism. In our study, 66 patients with negative results on preoperative scans were found to have a single adenoma and were surgically cured by minimally invasive/focused parathyroidectomy.