Diagnostic value of parathyroid localization techniques in surgery for primary hyperparathyroidism

Objective: To determine the accuracy of imaging techniques for localization of nodular lesions of parathyroid glands.

Methods: Seventy one patients were prospectively enrolled and underwent surgical examination for primary hyperparathyroidism. Ultrasonography (US), 201Tl/99mTc parathyroid subtraction scintigraphy and 99mTc MIBI scintigraphy were evaluated.

Results: The sensitivity and specificity for combined 201Tl/99mTc parathyroid subtraction scintigraphy and US for parathyroid adenomas were 72.27% and 89.22% respectively. The combination of 99mTc MIBI scintigraphy and US resulted in improved specificity (93.67%) and positive predictive value (80.39%). The accuracy of the localizing studies was lower for patients with hyperplasia.

Conclusions: The combination of scintigraphy and US is the best approach for localization of nodules. In most cases, the two techniques are complementary.