Background
Localizing studies are the key for determining the optimal surgical strategy in patients
with primary hyperparathyroidism (HP). Most of the data in the literature are retrospective
in nature and from analysis on a per patient basis. This is a prospective study looking
at the characteristics of the patient and the gland that determine the likelihood
of an abnormal parathyroid to be detected by ultrasonography (US) and sestamibi scan
(MIBI).
Methods
This is a prospective analysis of 1000 consecutive patients with HP who underwent
parathyroidectomy at a tertiary care center. The study group included HP with single
gland disease (63%), double adenoma (15%), as well as hyperplasia (15%), familial
HP (2%), and secondary/tertiary HP (6%). All patients underwent surgeon-performed
neck US followed by MIBI scan. Univariate logistic regression and multivariate analyses
were performed on pre- and intraoperative variables.
Results
A total of 1845 abnormal glands were analyzed. Overall, US was superior to MIBI for
the detection of abnormal glands in all subgroups. On multivariate analysis, body
mass index (BMI), gland size, and gland volume were the statistically significant
independent factors predicting detection by both US and MIBI in primary HP. The sensitivity
of US was better for single gland disease than for multigland disease in primary HP,
but the sensitivity of MIBI was similar in both groups. For a given size, hyperplastic
glands in primary HP imaged less well with US and MIBI than in familial or secondary/tertiary
HP.
Conclusion
This prospective study demonstrates that BMI and gland size independently predict
accurate detection of abnormal parathyroid glands by US and MIBI in sporadic primary
HP. Understanding the factors that affect the accuracy of parathyroid localization
tests will allow the surgeon to develop a successful surgical strategy in a given
patient.
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Article info
Publication history
Published online: May 22, 2008
Accepted:
March 25,
2008
Footnotes
Presented as a poster at the Twenty-Eighth Annual Meeting of the American Association of Endocrine Surgeons, Tucson, Arizona, April 28–May 1, 2007.
Identification
Copyright
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
