Diagnostic Accuracy of Ultrasonography Versus Sestamibi Scan in Preoperative Localization of Solitary Parathyroid Adenoma: A Cross-Sectional Analysis from a Tertiary Care Center in Bangladesh
Md. Nadim Uddin
*
Department of General Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
Md. Aminul Islam Joarder
Department of General Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
Ferdous Alam
Department of General Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
Md. Ashraful Islam
Department of General Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
Fahmida Sultana
Department of General Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
Shafayat Muhammad Shantonu
Department of Surgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
Noor Mohal
Department of Anesthesiology, Islami Bank Medical College, Rajshahi, Bangladesh.
Aktar-Uj-Jaman
Department of General Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
*Author to whom correspondence should be addressed.
Abstract
Background: Solitary parathyroid adenoma is the main etiological factor of primary hyperparathyroidism. Perfect preoperative localization is instrumental in ensuring focused parathyroidectomy in order to decrease complications.
Objective: This study aims to determine the accurate diagnostic tool between Ultrasonography and Sestamibi Scan to localize preoperative Solitary Parathyroid Adenoma.
Methodology: The study embraced a cross-sectional design conducted in the period of July 2022 to June 2023 at BSMMU, Dhaka. Conveniently, 14 PHPT patients with the biochemical diagnosis were added to the study because of a solitary adenoma. This study included 14 patients with ethical considerations. Demographics, clinical presentation, outcomes of imaging, intraoperative findings, and Biochemical Frozen section (BFS) were documented. Ultrasonography and Sestamibi Scan result was validated by BFS. The statistical analysis was accomplished with SPSS v22, and sensitivity, specificity, accuracy, PPV, and NPV were computed.
Results: The mean age was 32.36 ± 9.76 years, and predominance (71.4%) of male subjects was found. Most often, they presented to the medical center with renal symptoms (64.3%). USG had proper localization in 66.6% of cases with left lower lesions, 66.7% of right lower lesions, and 100-percent of right upper lesions, but false-negative to medial superior adenomas. Sestamibi scan revealed concordance between peroperative findings and scan findings of 100% at all sites. The validity test against BFS showed USG sensitivity 75.0%, specificity 50%, accuracy 71.4%, PPV 90.0 percent and NPV 25.0%. Sestamibi was sensitive with 100.0%, specificity of 0.0%, accuracy of 85.7%, PPV of 85.7% and NPV of 0.0.
Conclusion: According to the diagnosis accuracy, Sestamibi scan had a better diagnosis accuracy than USG, especially for ectopic adenomas. The combination of the two modalities would result in superior preoperative localization of solitary parathyroid adenoma, leading to optimization of surgical results.
Keywords: Parathyroid adenoma, ultrasonography, sestamibi scan, biochemical frozen section