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Factors related to a non-localising technetium 99m sestamibi scan result during parathyroid adenoma imaging in primary hyperparathyroidism.

Clinical Otolaryngology 2020 December 2
OBJECTIVES: The aim of this study is to investigate factors that are associated with having a non-localising 99m Tc-sestamibi scan.

DESIGN: A retrospective study was performed on patients that underwent parathyroid surgery performed within a single institution between 2001 and 2018.

SETTING: Single tertiary centre for parathyroid surgery.

PARTICIPANTS: 230 patients underwent surgery for primary hyperparathyroidism due to a solitary parathyroid adenoma and had pre-operative 99m Tc-sestamibi imaging.

MAIN OUTCOME MEASURES: Variables including age, gender, intra-operative location of parathyroid adenoma, adenoma weight and pre- & post-operative calcium and parathyroid hormone levels were investigated through univariate and multivariate analysis to identify any association with having a non-localising (negative) 99m Tc-sestamibi scan result.

RESULTS: Multivariate analysis identified that right-sided adenomas (p=0.038), superior adenomas (p=0.042) and a lower pre-operative PTH level (p=0.034) were all individual factors associated with having a negative 99m Tc-sestamibi scan result. Although the weight of the adenoma was significant on univariate analysis (p=0.029), this was not demonstrated on multivariate analysis (p=0.422).

CONCLUSION: Factors that were associated with having non-localising 99m Tc-sestamibi scan were right-sided adenomas, superior adenomas, and lower pre-operative PTH level. Further large prospective multicentre studies are needed to further evaluate these initial findings.

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