QPTH Results Biochemical FNA Differential Jugular Venous Sampling and Sestamibi Scans

A "biochemical" FNA of tissue for hormone content was performed multiple times in 32 patients. This technique had a sensitivity and specificity of 100% in differentiating parathyroid from nonparathyroid tissue.

Differential jugular venous sampling was performed in 89 patients with positive results (high levels on the side of the tumor) in 70%.

In our series, the sestamibi scan results, based on the radiologist's interpretation, correctly localized the offending parathyroid gland(s) (true positive) in 317 (79%) of 401 patients. In 26 patients, the scan incorrectly localized the overactive parathyroid gland (false positive/false negative). A second overactive gland was overlooked by the sestamibi scan in 12 of 401 patients (true positive/false negative), and another 11 had a second spot(s) falsely identified as positive (true positive/false positive). Of 22 patients with completely negative scans, 13 had differential jugular venous sampling. Eight of these patients had a positive differential allowing a successful unilateral neck exploration.

The sestamibi scans were incorrect in 20% of cases. The QPTH was useful in identifying and correcting these mistaken localization studies in all 80 patients (20%) with the use of differential venous sampling and the intraoperative PTH monitoring interpreted with the described criterion.

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