American Association of Endocrine SurgeonsCorrelation of parathyroid scanning and anatomy in 261 unselected patients with sporadic primary hyperparathyroidism☆
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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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.