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Background/Aim. Parathyroid hyperplasia (PHP) is defined as an absolute  increase in the mass of parenchymal cells of the parathyroid gland. PHP is  classified as primary, secondary and tertiary. The enlargement of parathyroid  glands (PG) is usually asymmetric, resulting in a “dominant“ gland. In order  to confirm the diagnosis, at least two glands should be examined  histologically. Subtotal parathyroidectomy, i.e. removal of the three PG and  leaving a small remnant of the forth, is the treatment of choice. High  percent of PHP recurrence imposes the need for preoperative high sensitivity  localizing procedures. Parathyroid scintigraphy localizes about 60% of  hyperplastic glands. The aim of this study was to correlate findings of  subtraction parathyroid scintigraphy (SPS) with weight, pathohistologic  finding and oxyphil cell (OC) content of PG in patients with primary,  secondary and tertiary parathyroid hyperplasia. Methods. Twenty-seven  patients with primary/secondary PHP underwent SPS before surgery.  Scintigraphic results were graded from 1-5, in relation to the degree of  uptake. SPS graded 3, 4 and 5 were considered positive. The number and weight  of operated PG were evaluated macroscopically. Pathohistologic and cellular  types were defined on standard stained hematoxylin-eosin slides. OC content  was defined as a percent of OC and graded from 1 to 3: grade 1 < 10%, grade 2  ≥ 10% and grade 3 ≥ 20% of OC. Results. SPS localized dominant gland in all  patients with sensitivity 100%, and 51 from 73 hyperplastic PG, with  sensitivity per gland of 70%. PG weighed 0.1 g to 6.7 g (median 1 g). A  significant positive correlation (p < 0.0001) was found between the SPS  results and PG weight. A significant positive correlation was found between  PG weight and OC content (p = 0.0002). An insignificant correlation was found  between SPS and OC content. Thirty-eight PG had < 10% of OC, 32 PG had < 10%  and 3 PG had ≥ 20% of OC. Four patients had diffuse PHP and 23 patients  nodular PHP. There was no statistically significant difference in SPS results  compared to hyperplasia type, and between OC content and hyperplasia type. A  significant positive correlation (p = 0.05) was found between PG weight and  hyperplasia type. Conclusion. A high positive correlation was found between  SPS results and PG weight, PG weight and OC content and PG weight and  hyperplasia type. Between SPS results and OC content, and between SPS results  and hyperplasia type, an insignificant correlation was found. Our results  showed that SPS is a reliable and very sensitive diagnostic tool in detecting  abnormal PG in parathyroid hyperplasia, reaching 100% sensitivity in  detecting a “dominant gland” and sensitivity per localized gland of 70%.  Causes that affect increased uptake of liposolubile Tc99m  radiopharmaceuticals (RF) in the hyperfunctional PG tissue and conditions  which prevent RF admission into the PG cells still remain to be accurately  and precisely determined

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Correlation of subtraction parathyroid scintigraphy with weight, pathohistologic finding and oxyphil cell content of parathyroid glands in parathyroid hyperplasia