Evaluation of diagnostic accuracy of Sest-amibi Scan for preoperative localization of affected parathyroid gland in patients with primary hyperparathyroidism.

Abstract

Paraclinical modalities which assist in preoperative localization of pathologies of the parathyroid gland play an important role in clinical decision making and surgical procedures of patients with primary hyperparathyroidism and determine the prognosis of such patients. One of the most common technique among these variety of modalities is Sestamibi Scan which performs by Technetium 99m radiopharmaceuticals. With a high sensitivity, it is able to determine the position of parathyroid lesions among these patients, which can be applied to almost all patients and can reduce the aggressive surgical dissection also reducing the duration of hospitalization and long-term complications of surgery. Materials and Methods: In this cross-sectional study 25 individuals with primary hyperparathyroidism who referred to the endocrinology clinic of Emam Reza Hospital of Tabriz from 1395 to 1397 were enrolled. All patients underwent Sestamibi scan before surgery. By comparing the results of the scans with surgical findings as the gold standard the accuracy and the diagnostic value of this scan in localization of parathyroid gland pathologies had been evaluated. Results: There was no significant relationship between age and sex of the patients with sensitivity of Sestamibi scan (p>0.05). Regarding to the sensitivity of scan, according to the interoperation findings and pathologic confirmation of resected tissues the sensitivity of the Sestamibi scan in localization of pathologic gland calculated as 84.6%. The specificity, positive predictive value and negative predictive value for the test were 95.6%, 89.6% and 94.8% respectively. The results of the scan and reported pathologies showed a 95% overlapping. There was a significant correlation between the type of pathologies of the gland and the sensitivity of Sestamibi scan (Pvalue=0.002). There was no relationship found between the number of affected glands and the diagnostic ability of the scan (p=0.33). No significant correlation was found between location of the affected gland and sensitivity of the scan. The pre and post-operative serum level of parathyroid hormone (PTH) was not significantly correlated with sensitivity of Sestamibi scan (p>0.05).