Effectiveness of surgeon interpretation of technetium tc 99m sestamibi scans in localizing parathyroid adenomas.

OBJECTIVES To evaluate the ability of surgeons to predict the laterality of parathyroid adenomas from technetium Tc 99m sestamibi scans and compare their results with the radiologic interpretations. DESIGN Retrospective medical record review with single- blinded review of sestamibi scans. SETTING Tertiary care academic medical center PATIENTS The study population included 110 consecutive parathyroidectomy cases from January 2001 to June 2004. Inclusion criteria were biochemically proven primary hyperparathyroidism, with documented serum hypercalcemia and elevated parathyroid hormone levels. Only cases due to a single adenoma that were cured with a single surgical procedure were included. INTERVENTION All patients underwent resection of a parathyroid adenoma following a preoperative sestamibi localization study and serum calcium and parathyroid hormone level analysis. MAIN OUTCOME MEASURE Adenoma location was determined from a review of operative and pathological reports. Two head and neck surgeons performed a blinded review of all scans, and their findings were compared with the radiology reports. RESULTS Of 82 adenomas, 51 (62%) were correctly lateralized in the radiology report, while the other 31 were interpreted as normal scans. The sensitivity and specificity of the radiologic interpretations for parathyroid adenomas in all patients with primary hyperparathyroidism were 62% and 83%, respectively. The scan interpretation of the 2 surgeons produced accurate lateralization of 91% and 91% of these single adenomas. Of the 31 single adenoma scans read as normal by the radiologist, the surgeons correctly lateralized 22 of 29 (76%) and 21 of 28 (75%) of the adenomas. CONCLUSION The review of sestamibi scans by surgeons allows accurate localization of parathyroid adenomas that may not be identified by standard radiologic interpretations.