Comparative Accuracy of Ultrasonography and Sestamibi Scintigraphy in Preoperative Localization of Parathyroid Adenomas: A Retrospective Observational Study

Abstract

Background: Minimally invasive parathyroidectomy (MIP) has become the standard approach in managing primary hyperparathyroidism (PHPT), contingent on precise preoperative localization of the offending parathyroid adenoma. Among the most commonly used localization tools are high-resolution ultrasonography (USG) and Tc-99m sestamibi scintigraphy.

Methods: This retrospective observational study included 100 patients with biochemically confirmed PHPT who underwent both USG and Tc-99m sestamibi scintigraphy prior to parathyroidectomy at a tertiary care center between January and December 2024. The sensitivity and anatomical localization accuracy of both modalities were compared against surgical and histopathological findings.

Results: Sestamibi scintigraphy demonstrated higher sensitivity (87%) compared to ultrasonography (79%). Misclassification of superior/inferior position occurred in 12% and 8% of cases for USG and sestamibi respectively. No significant correlation was observed between biochemical parameters and imaging accuracy.

Conclusion: Sestamibi scintigraphy is more sensitive for preoperative localization of parathyroid adenomas, especially for ectopic or deep-seated glands. A combined imaging approach offers optimal guidance for MIP.