Abstract
Background. There is considerable controversy today concerning the most appropriate surgical
approach for patients with primary hyperparathyroidism. The conventional surgical
operation involves a bilateral neck exploration through a collar incision with identification
of all parathyroid tissue and removal of abnormal parathyroid glands while the patient
is under general anesthesia. The success rate of this operation is about 95% or greater
in the hands of an experienced endocrine surgeon. Preoperative localization techniques
are generally considered to be unnecessary before initial parathyroid operations.
The purpose of this investigation was (1) to evaluate the individual and combined
accuracy of ultrasonography and technetium 99m sestamibi scans in localizing abnormal
parathyroid glands and (2) to determine whether such scans could be used to direct
a focused operation. Methods. We retrospectively studied 338 patients with sporadic primary hyperparathyroidism
who had preoperative neck localization studies, ultrasonography and/or technetium
99m sestamibi scans, and parathyroid exploration (238 patients or, reexploration,
60 patients) from January 1996 to April 2000 at the University of California San Francisco/Mount
Zion Medical Center. The preoperative localization studies were recorded as true-positive,
false-positive, and false-negative and compared with the surgical and pathologic findings
and with the outcome of the operation. Results. All of the abnormal parathyroid glands were correctly identified by ultrasonography
in 184 of 303 patients (60.7%) and by technetium 99m sestamibi scanning in 183 of
237 patients (77.2%). The sensitivities of ultrasonography and sestamibi were 65%
and 80%, respectively. Among the 202 patients who received both ultrasonography and
sestamibi scans, a parathyroid tumor was identified at the same site in 105 (52%)
of them. When both techniques identified a parathyroid tumor at the same site, the
tests were correct in 101 of 105 patients and the sensitivity increased to 96%. Conclusions. When both the ultrasonography and sestamibi scans identified the same, solitary parathyroid
tumor in patients with sporadic primary hyperparathyroidism, this was the only abnormal
parathyroid gland in 96% of the patients. A focused parathyroidectomy could therefore
be performed in such patients with an acceptable (~95%) success rate. (Surgery 2001;129:720-9.)
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Article info
Publication history
Accepted:
January 19,
2001
Footnotes
*Reprint requests: O. H. Clark, MD, Chief of Surgery, UCSF/Mount Zion Medical Center, 1600 Divisadero St, Box 1674, San Francisco, CA 94143-1674.
**Surgery 2001;129:720-9.
Identification
Copyright
© 2001 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
