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Role of 99mTc-sestamibi SPECT in accurate selection of primary hyperparathyroid patients for minimally invasive radio-guided surgery

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Abstract

Purpose

A prerequisite for optimum minimally invasive radio-guided surgery (MIRS) for primary hyperparathyroidism (PHPT) is the demonstration of significant uptake of 99mTc-sestamibi in a parathyroid adenoma (PA). The aim of this study was to evaluate the clinical role or 99mTc-sestamibi SPECT in selecting patients for this procedure.

Methods

Fifty-four consecutive PHPT patients were evaluated by single-session 99mTc-pertechnetate/99mTc-sestamibi planar subtraction scintigraphy, followed by 99mTc-sestamibi SPECT acquisition to localise hyperfunctioning PAs and assist in planning the surgical approach.

Results

Scintigraphy showed the presence of a solitary PA in 47/54 patients (87%) and two or more PAs in four patients (7.4%); it was negative in the remaining three patients (5.6%). The overall sensitivity of 99mTc-sestamibi scintigraphy was 94.6%. In 7/54 patients, the PA was located deep in the para-oesophageal/paratracheal space. So far, 22 patients with scintigraphic evidence of a solitary PA (in four of whom the PA was located deep in the neck) have undergone successful MIRS using the low 37 MBq (1 mCi) 99mTc-sestamibi dose protocol. Intraoperative quick parathyroid hormone (QPTH) assay demonstrated a fall in all 22 patients, thus confirming successful removal of the hyperfunctioning PA. No major surgical complications were observed. After a period of follow-up ranging between 6 and 27 months (median 13 months), no case of persistent/recurrent PHPT was recorded. When comparing the parathyroid to background (P/B) ratio measured at planar and SPECT preoperative scintigraphy with that measured intraoperatively with the gamma probe, a good linear correlation was found between the SPECT and the intraoperative gamma probe measurements (r=0.89; p<0.01) but no correlation was found with planar scintigraphic data.

Conclusion

Our preliminary data suggest that measurement of the P/B ratio by means of 99mTc-sestamibi SPECT is more accurate in predicting the intraoperative measurements with the gamma probe. In this respect, a preoperative 99mTc-sestamibi SPECT acquisition should be recommended for better selection of PHPT patients in whom a MIRS approach can be offered.

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Authors and Affiliations

  1. Nuclear Medicine Service - PET Unit, ‘S. Maria della Misericordia’ Hospital, Istituto Oncologico Veneto (IOV), Viale Tre Martiri, 140, 45100, Rovigo, Italy

    Domenico Rubello, Arianna Massaro, Silvia Cittadin & Lucia Rampin

  2. Department of Nuclear Medicine, Hammersmith Hospital, London, UK

    Adil Al-Nahhas

  3. Regional Center of Nuclear Medicine, University of Pisa Medical School, Pisa, Italy

    Giuseppe Boni & Giuliano Mariani

  4. Department of Special Surgery, University of Padova Medical School, Padova, Italy

    Maria Rosa Pelizzo

Authors
  1. Domenico Rubello
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  2. Arianna Massaro
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  3. Silvia Cittadin
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  4. Lucia Rampin
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  5. Adil Al-Nahhas
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  6. Giuseppe Boni
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  7. Giuliano Mariani
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  8. Maria Rosa Pelizzo
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Corresponding author

Correspondence to Domenico Rubello.

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Rubello, D., Massaro, A., Cittadin, S. et al. Role of 99mTc-sestamibi SPECT in accurate selection of primary hyperparathyroid patients for minimally invasive radio-guided surgery. Eur J Nucl Med Mol Imaging 33, 1091–1094 (2006). https://doi.org/10.1007/s00259-006-0162-y

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  • DOI: https://doi.org/10.1007/s00259-006-0162-y

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