Relationship of technetium Tc 99m sestamibi scans to histopathological features of hyperfunctioning parathyroid tissue.

OBJECTIVE

To investigate the histopathological features of pathologic parathyroid specimens associated with negative preoperative technetium Tc 99m sestamibi scans.

DESIGN

Retrospective study.

SETTING

Tertiary care center.

PATIENTS: One hundred fourteen patients who underwent sestamibi scans before surgical exploration for primary hyperparathyroidism between 1996 and 2001.

INTERVENTIONS: Surgical exploration and removal of parathyroid adenomas.

MAIN OUTCOME MEASURES: Histopathological characteristics associated with true-positive and false-negative sestamibi scans, including parathyroid specimen weight, size, relative oxyphil and chief cell content, parathyroid hormone staining patterns, cellular architecture, and various immunohistochemical staining patterns.

RESULTS

Twenty-three (24%) of 98 patients with parathyroid adenomas had negative sestamibi scan results. Among 20 age- and sex-matched patients with false-negative results vs 20 patients with true-positive results, tumor size (P = .04) and oxyphil cell content (P = .03) were found to be significantly different.

CONCLUSION

Parathyroid gland size and oxyphil content are descriptive and predict differences between sestamibi properties of parathyroid adenomas but have no current therapeutic implications for parathyroid surgery.