Preoperative parathyroid localization with sestamibi

PURPOSE: Results of noninvasive preoperative parathyroid localization with technetium^99m-labeled sestamibi are reported in a series of 51 patients. PATIENTS AND METHODS: Forty-four patients had hyperparathyroidism surgically treated for the first time and seven patients underwent reexploration for recurrent or persistent hyperparathyroidism. Preoperative scintigraphy with sestamibi was performed in all patients before surgical exploration. Results of the radionuclide studies were compared with surgical and pathologic findings. RESULTS: Twenty-six patients had solitary adenomas. All 26 were localized preoperatively by the scans. Among 18 patients with multiglandular pathology, 69 pathological glands were found at surgery. Thirty-six of these glands, in 15 patients, were localized by the scans. Among the 7 patients evaluated after failed exploration or recurrent hyperparathyroidism, 7 pathologic glands were found, of which 6 were correctly localized by the scan. Ectopic lesions in 2 patients were correctly localized by the scan. CONCLUSIONS: The authors conclude that sestamibi parathyroid localization is an effective method for preoperative parathyroid localization, with accuracy exceeding that of other noninvasive studies.