{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:07:28Z","timestamp":1777507648468,"version":"3.51.4"},"reference-count":20,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2016,1,5]],"date-time":"2016-01-05T00:00:00Z","timestamp":1451952000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2016,1,5]],"date-time":"2016-01-05T00:00:00Z","timestamp":1451952000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Focused parathyroidectomy in primary hyperparathyroidism (1\u00b0HPT) is possible with accurate preoperative localization and intraoperative PTH monitoring (IOPTH). The added benefit of multimodal imaging techniques for operative success is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Patients with 1\u00b0HPT, who underwent parathyroidectomy in 2012\u20132014 at a single institution, were retrospectively reviewed. Only the patients who underwent the standardized multimodal imaging workup consisting of <jats:sup>123<\/jats:sup>I\/<jats:sup>99<\/jats:sup>Tc\u2010sestamibi subtraction scintigraphy, SPECT, and SPECT\/CT were assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 360 patients who were identified, a curative operation was performed in 96 %, using pre\u2010operative imaging and IOPTH. Imaging analysis showed that <jats:sup>123<\/jats:sup>I\/<jats:sup>99<\/jats:sup>Tc\u2010sestamibi had a sensitivity of 86 % (95 % CI 82\u201390 %), positive predictive value (PPV) 93 %, and accuracy 81 %, based on correct lateralization. SPECT had a sensitivity of 77 % (95 % CI 72\u201382 %), PPV 92 % and accuracy 72 %. SPECT\/CT had a sensitivity of 75 % (95 % CI 70\u201380 %), PPV of 94 %, and accuracy 71 %. There were 3 of 45 (7 %) patients with negative sestamibi imaging that had an accurate SPECT and SPECT\/CT. Of 312 patients (87 %) with positive uptake on sestamibi (93 % true positive, 7 % false positive), concordant findings were present in 86 % SPECT and 84 % SPECT\/CT. In cases where imaging modalities were discordant, but at least one method was true\u2010positive, <jats:sup>123<\/jats:sup>I\/<jats:sup>99<\/jats:sup>Tc\u2010sestamibi was significantly better than both SPECT and SPECT\/CT (<jats:italic>p<\/jats:italic> &lt; 0.001). The inclusion of SPECT and SPECT\/CT in 1\u00b0HPT imaging protocol increases patient cost up to 2.4\u2010fold.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p><jats:sup>123<\/jats:sup>I\/<jats:sup>99<\/jats:sup>Tc\u2010sestamibi subtraction imaging is highly sensitive for preoperative localization in 1\u00b0HPT. SPECT and SPECT\/CT are commonly concordant with <jats:sup>123<\/jats:sup>I\/<jats:sup>99<\/jats:sup>Tc\u2010sestamibi and rarely increase the sensitivity. Routine inclusion of multimodality imaging technique adds minimal clinical benefit but increases cost to patient in high\u2010volume setting.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-015-3389-6","type":"journal-article","created":{"date-parts":[[2016,1,5]],"date-time":"2016-01-05T17:37:29Z","timestamp":1452015449000},"page":"589-594","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["A Multimodal Imaging Protocol, <sup>123<\/sup>I\/<sup>99<\/sup>Tc\u2010Sestamibi, SPECT, and SPECT\/CT, in Primary Hyperparathyroidism Adds Limited Benefit for Preoperative Localization"],"prefix":"10.1002","volume":"40","author":[{"given":"Grace S.","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Surgery Mayo Clinic 200 First St. SW 55905 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Travis J.","family":"McKenzie","sequence":"additional","affiliation":[{"name":"Department of Surgery Mayo Clinic 200 First St. SW 55905 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian P.","family":"Mullan","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine Mayo Clinic Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David R.","family":"Farley","sequence":"additional","affiliation":[{"name":"Department of Surgery Mayo Clinic 200 First St. SW 55905 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoffrey B.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Surgery Mayo Clinic 200 First St. SW 55905 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melanie L.","family":"Richards","sequence":"additional","affiliation":[{"name":"Department of Surgery Mayo Clinic 200 First St. SW 55905 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,1,5]]},"reference":[{"key":"e_1_2_7_2_2","first-page":"245","article-title":"Therapeutisher versuch bein falls von ostitis fibrosa generalisata mittles. 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