Elsevier

Surgery

Volume 126, Issue 6, December 1999, Pages 1123-1131
Surgery

American Association of Endocrine Surgeons
Correlation of parathyroid scanning and anatomy in 261 unselected patients with sporadic primary hyperparathyroidism

Presented at the 20th Annual Meeting of the American Association of Endocrine Surgeons, New Haven, Conn, May 2-4, 1999.
https://doi.org/10.1067/msy.2099.101579Get rights and content

Abstract

Background: Despite abundant literature on parathyroid scanning with technetium 99m-labeled cationic complexes, comprehensive clinical reports that unequivocally correlate scanning findings with the anatomy of parathyroid glands in extensive and homogenous cohorts of patients are lacking. Methods: We analyzed the records of patients with sporadic primary hyperparathyroidism who had had a preoperative scan with either 99mTc-labeled sestamibi or 99mTc-labeled tetrofosmin at our institution and who were cured after a bilateral surgical neck exploration procedure. Results: In 261 patients, 710 normal and 347 abnormal glands (1494 ± 2626 mg), including 15 glands within the mediastinum, were identified. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of scanning were 82%, 98%, 91%, 94%, and 94%, respectively, in 197 patients with uniglandular disease and 53%, 98%, 98%, 60%, and 72%, respectively, in 64 patients with multiglandular disease. False-positive uptakes were encountered in 17 patients (7%), 3 false-positive uptakes being within the mediastinum. If the unilateral approach had been followed, guidance with preoperative scanning would have significantly increased the number of effective unilateral neck exploration procedures (164 patients (63%) vs 78 patients (30%); P < .001). One abnormal gland would also have been neglected in 28 patients (11%). Conclusions: Preoperative scanning would limit neck exploration procedures in two thirds of patients with sporadic primary hyperparathyroidism but may also increase the risk of failure in the most challenging cases. (Surgery 1999:126:1123-31.)

Section snippets

Patients and methods

In this retrospective study, we reviewed the medical records of patients with documented sporadic primary hyperparathyroidism who had a preoperative parathyroid scanning with 99mTc-labeled cationic complexes (99mTc-labeled sestamibi or 99mTc tetrofosmin scanning) and whose condition returned to normocalcemia after parathyroidectomy through a classic bilateral cervicotomy at our institution between January 1993 and December 1997.

All parathyroid scans were performed at our institution by the same

Results

Table I summarizes the clinical characteristics of the 261 patients (female to male ratio, 3.7), with preoperative parathyroid scanning with 99mTc-labeled sestamibi or 99mTc-labeled tetrofosmin who were included in this study. Hyperparathyroidism was cured in all patients after bilateral neck exploration and in 2 patients after sternotomy. Permanent recurrent laryngeal nerve injury or hypocalcemia did not occur. A solitary adenoma was found at surgery in 197 cases (75%), but the disease was

Discussion

Numerous alternative strategies, such as the unilateral approach or minimally invasive neck surgery, have recently been proposed to challenge the paradigm of routine bilateral cervical exploration procedures for sporadic primary hyperparathyroidism. Accurate preoperative localization of abnormal parathyroid glands is crucial to ensure the clinical relevance of these approaches. Despite the abundant literature available on 99mTc-labeled sestamibi parathyroid scanning,3 comprehensive clinical

Conclusion

Although objective evidence of the cost-effectiveness benefits of routine parathyroid scanning before surgical treatment of primary hyperparathyroidism has not been clearly established, most patients have already undergone parathyroid scanning when referred to surgeons. Furthermore, an increasing number of authors are now considering less invasive approaches for parathyroidectomy and consequently advocating the routine use of parathyroid preoperative imaging. In this study, we confirmed that

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  • Cited by (0)

    Reprint requests: Professor Charles Proye, Clinique Chirurgicale Adulte Est, Service de Chirurgie Générale et Endocrinienne, Hopital Huriez, Centre Hospitalier et Universitaire de Lille, 1 Place de Verdun, 59037 Lille, France.

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