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Antonia E. Stephen, MD; Sanford I. Roth, MD; David W. Fardo, MS; Dianne M. Finkelstein, PhD; Gregory W. Randolph, MD; Randall D. Gaz, MD; Richard A. Hodin, MD

Arch Surg. 2007;142(4):381-386.

Objective  To investigate why some patients with single parathyroid adenomas have negative preoperative sestamibi scans.

Design  Retrospective review.

Setting  Tertiary care center.

Patients  Twenty-one patients with false-negative (FN) scans were compared with 22 patients with true-positive (TP) scans. All patients had single parathyroid adenomas.

Interventions  Neck exploration and removal of parathyroid adenomas.

Main Outcome Measures  Age; sex; preoperative serum calcium and parathyroid hormone levels; gland weight; location; and pathologic features.

Results  There was no significant difference in age or preoperative serum calcium or parathyroid hormone levels. Gland weight was greater in the TP group compared with the FN group (mean ± SD, 1336 ± 1603 mg vs 475 ± 365 mg; P = .04); 13 (62%) of the 21 glands in the FN group were located in the upper position, compared with 6 (27%) of the 22 glands in the TP group (P = .03). Ten of the 22 glands in the TP group consisted predominantly of oxyphil cells, compared with 2 of the 21 glands in the FN group (P = .02). A multivariate logistic regression model yielded the following factors that predicted an accurate scan: higher percentage of oxyphil cells (P = .03), heavier gland (P = .03), female sex (P = .04), and gland location in the lower position (P = .04).

Conclusions  Smaller-volume parathyroid adenomas and those in the upper position are less likely to be localized with sestamibi scans. A TP scan correlates with oxyphil cell predominance, supporting a role for the mitochondrial-rich cell in sestamibi uptake and retention.

Author Affiliations: Departments of Surgery (Drs Stephen, Randolph, Gaz, and Hodin) and Pathology (Dr Roth) and the Biostatistics Center (Mr Fardo and Dr Finkelstein), Massachusetts General Hospital and Harvard Medical School, Boston, Mass.