ECE2023 Eposter Presentations Calcium and Bone (99 abstracts)
Evaluation of ultrasonography and 99mTc-sestamibi scintigraphy in the preoperative imaging study in Primary Hyperparathyroidism
Amelia Oleaga 1,2 , Alejandra Santamaría 1 , Fernando Goñi 1,2 , Cristina Moreno 1 , Ana Izuzquiza 1 , Javier Espiga 1 , Vanessa Arosa 1 , Andoni Monzón 1 , Miren Josune Rodríguez-Soto 1 , Jon Izquierdo 1 , Natalia Iglesias 1 , Jon Garai 1 , Laura Calles 1 , Iñigo Hernando 1 , Aitzol Lizarraga 1,2 , Estíbaliz Ugarte 1 & Miguel Paja 1,2
1University Basurto Hospital, Endocrinology and Nutrtion, Bilbao, Spain; 2Basque Country University, Bilbao, Spain
Introduction: Minimally invasive surgery has become the standard surgical procedure in Primary Hyperparathyroidism (PHP). Targeted parathyroidectomy is associated with a shorter operative duration, a lower risk of complications and a greater patient satisfaction. This approach is dependent on precise localization of the abnormal gland. 99mTc-sestamibi scintigraphy and ultrasonography are acceptable imaging modalities to detect parathyroid adenoma prior to operation but discrepancies exist with regard to diagnostic accuracy. 18F-fluorocholine positron emission tomography has shown promise results but its availability is only in a few centres. The aim of the present study was to evaluate the efficacy of 99mTc-sestamibi scintigraphy and ultrasonography in surgery for primary hyperparathyroidism.
Subjects and Methods: This is a retrospective observational cohort study in 117 patients diagnosed of PHP who were operated on between January 2017 and January 2022. There were 28 males and 89 females, age range: 35-87 years. All patients underwent ultrasonography and 99mTc-sestamibi scintigraphy before surgery. Surgical procedure was neck exploration (n=42) or selective parathyroidectomy (n=75), according to imaging localization. Statistical analyses used SPSSv20.0 software. Approval of the ethics and research committee was obtained for the study.
Results: Demographic, preoperative, interventional and cure data were compared according to ultrasonography and 99mTc-sestamibi scintigraphy results, distinguishing 3 patient groups: concordant n=68, discordant n=26, negative n=23. Gland weight P=0.03 in ultrasonography, and gland size in 99mTc-sestamibi scintigraphy (P=0.02), but no concomitant thyroid pathology rates, differed significantly between the positive and negative imaging results groups. In the 117 patients, sensitivity was 68% and PPV 81% for ultrasonography, and respectively 74% and 78% for 99mTc-sestamibi scintigraphy. Both modalities were concordant in 68/117 (58%) and in 58 consistent with surgery result (sensitivity 53%). Histopathological analysis showed: 109 adenomas, 1 carcinoma, 5 multiple adenomas. In 2 patients no lesion was shown. In 110 out of 117, calcemia and PTH were normalized one and six months after surgery.
Conclusion: The performance of associated ultrasonography and 99mTc-sestamibi scintigraphy could be the ideal practice to precisely localize parathyroid lesion in patients with PHPT. Combining both techniques can reduce surgical morbidity.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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