Elsevier

Surgery

Volume 134, Issue 6, December 2003, Pages 1038-1041
Surgery

Negative preoperative localization studies are highly predictive of multiglandular disease in sporadic primary hyperparathyroidism

https://doi.org/10.1016/j.surg.2003.07.021Get rights and content

Abstract

Background

The development of localization studies and quick parathyroid hormone assay (QPTH) has allowed the development of focused surgery in sporadic primary hyperparathyroidism. The aim of this investigation was to determine whether localization studies select a specific population of patients.

Methods

From 1999 to 2001, 213 patients underwent surgery for sporadic primary hyperparathyroidism. All were investigated with sestamibi scanning and ultrasonography. When at least 1 study showed a positive result (n = 175), the patient underwent a video-assisted approach with QPTH. When results were negative (n = 38), the patient underwent cervicotomy and exploratory procedures of all 4 parathyroid glands.

Results

All patients are cured (mean follow-up, 17.8±10.3 months [SD]). Patients with negative preoperative study results had a high risk of multiglandular disease (12/38 patients; 31,6%), compared with patients with 1 positive study result (3/83 patients; 3.6%; P<.0001) and those with 2 concordant positive study results (0/92 patients; P<.0001).

Conclusion

When preoperative localization study results are negative, the patient has a high risk of multiglandular disease, and a conventional cervicotomy with identification of the 4 glands is recommended strongly. When only 1 localization study is positive, the risk of multiglandular disease justifies the use of QPTH during a focused approach. When positive localization study results are concordant, the use of QPTH is questionable during a focused approach.

Section snippets

Patients and methods

From 1999 to 2001, 213 patients were eligible for a video-assisted approach and underwent preoperative localization studies that included sestamibi scanning and ultrasonography. The study result was considered to be positive when it showed an image that was considered compatible with a parathyroid adenoma. The study result was considered to be negative when it did not identify any image that was compatible with a parathyroid adenoma. The preoperative studies were performed blinded from the

Demographics and preoperative tests

From 1999 to 2001, 172 women and 41 men underwent surgery for SPHPT in our department and were included in this retrospective investigation. The mean age was 59.5±14.7 years (range, 16-89 years). The mean preoperative calcium level was 2.86±0.25 mmol/L (range, 2.4-4.03 mmol/L). The mean preoperative parathyroid hormone level was 158±113 pg/mL (range, 44-725 pg/mL).

We observed no difference in terms of sex or age between the groups of patients with negative or positive preoperative localization

Discussion

The results of localization studies in our study are comparable to those reported in other studies.7 Sestamibi scanning is the most reliable preoperative localization test in our department; the sensitivity of ultrasonography is only 48%. However, most patients who were referred to our department had already had this investigation performed elsewhere. As in other reports, localization studies are less efficient in the presence of multiglandular disease.

The high rate of cured patients could be

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Presented at the 24th Annual Meeting of the American Association of Endocrine Surgeons, San Diego, California, May 11-14, 2003.

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