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What Does a Negative Sestamibi Scan Reveal About Single Parathyroid Adenomas?
Antonia E Stephen, Sanford I Roth, David W Fardo, Dianne M Finkelstein, Gregory W Randolph, Randall D Gaz, Richard A Hodin
Massachusetts General Hospital, Boston, MA
Objective: To investigate why some patients with single parathyroid adenomas have negative pre-operative sestamibi scans.
Design: Retrospective review.
Setting: Tertiary care center.
Patients: Twenty-one patients with false negative (FN) scans were compared to 22 patients with true positive (TP) scans. All patients had single adenomas. Interventions: Neck exploration and removal of parathyroid adenomas.
Main Outcome Measures: Age, sex, calcium and parathyroid hormone levels; gland weight, location, and pathology.
Results: There was no difference in age, calcium, or parathyroid hormone levels. Gland weight was greater in the TP group, compared with the FN group (1336 +/- 1603 mg versus 475 +/- 365 mg (mean +/- stddev); (p = 0.0445). Fourteen of the 21 glands (67%) in the FN group were located in the upper position, compared to 6 of the 22 (27%) glands in the TP group (p = 0.0148). Ten of the 22 glands in the TP group consisted predominantly of oxyphil cells, compared to 2 of the 21 glands in the FN group (p = 0.0157). A multivariate logistic regression model yielded the following factors which predict an accurate scan: higher percentage of oxyphil cells (p = 0.0270), heavier gland (p = 0.0305), female gender (p = 0.0414), and gland location in the lower position (p = 0.0495).
Conclusions: Smaller volume parathyroid adenomas and those in the upper position are less likely to localize on sestamibi scans. A true positive scan correlates with oxyphil cell predominance, supporting a role for the mitochodrial-rich cell in sestamibi uptake and retention.
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