There is general consensus that parathyroid excision is the treatment of choice for primary hyperparathyroidism. Minimally invasive surgery with limited neck exploration has the benefits of reduced operative and recovery times, less complications and excellent cosmetic results. However the success of unilateral neck exploration depends on the accurate preoperative localization of a parathyroid adenoma.
To assess the sensitivity and specificity of a combined MIBI and Ultrasound scan approach to identifying parathyroid adenoma.
Method: We reviewed 28 patients who had MIBI and ultrasound scans and subsequent surgery between July 02 to November 04. All Ultrasounds were performed and reported by single operator. Result of the MIBI scan was available before Ultrasound. All 28 patients who had biochemically proven Primary Hyperparathyroidism subsequently underwent neck exploration.
Correct localisation of tumour side by combined scanning techniques was 24/28 (85%)MIBI alone was correct 21/28 (75%) and USS alone 15/28(53%). Correct localisation of tumour side and location (upper Vs lower) by combined scanning was 21/28(75%). MIBI alone19/28 (68%) ultrasound alone in 14/28(50%). The false negative rate was 4/28(14%) and there were no false positive results. There were 11 multinodular goitres in our series. In these patients using MIBI alone there were 2 false negatives but USS was positive in these 2. Using USS alone there were 4 false negatives but MIBI was positive in all 4.
In our experience excellent pre operative localization was achieved by using a combined USS and MIBI approach. Combined MIBI and USS were particularly useful for localizing parathyroid adenoma in patients with multinodular goitres.