Parathyroid carcinoma can appear negative on 99mTc-sestamibi scintigraphy; therefore, comprehensive evaluation with both ultrasound and computed tomography is essential. In cases with discordant imaging and multiple lesions, bilateral internal jugular venous parathyroid hormone sampling serves as a decisive adjunct to guide en bloc resection when carcinoma is suspected. Preoperative evaluation for concurrent thyroid nodules is recommended during parathyroid surgery planning to avoid the need for secondary neck procedures.
Wang et al. (2026) studied this question.