Background
Hyperfunctioning ectopic glands remain an operative challenge in patients with sporadic
primary hyperparathyroidism. This study examines the incidence of ectopic glands and
the utility of sestamibi scans (MIBI), surgeon-performed ultrasonography, and intraoperative
parathormone monitoring in such patients undergoing parathyroidectomy.
Methods
We conducted a retrospective analysis of prospectively collected data from patients
who underwent parathyroidectomy from 1980 to 2011 for sporadic primary hyperparathyroidism
at a single institution. Demographics, localizing imaging studies, intraoperative
parathyroid monitoring dynamics, and surgical outcome for patients with hyperfunctioning
ectopic parathyroid glands were studied.
Results
Among 1,195 patients who underwent parathyroidectomy for sporadic primary hyperparathyroidism,
120 patients (10%) had hyperfunctioning ectopic glands, which were localized to the
neck (n = 66) and mediastinum (n = 54). MIBI had a sensitivity of 85%, specificity of 97%, and positive predictive
value (PPV) of 91% for ectopic glands in the neck, whereas in the mediastinum there
was a sensitivity of 88%, specificity of 95%, and PPV of 86%. Surgeon-performed ultrasonography
had a sensitivity of 81%, specificity of 98%, and PPV of 95% for neck ectopic glands.
The overall accuracy of surgeon-performed ultrasonography, MIBI, and intraoperative
parathyroid monitoring in the neck or mediastinum was 93%. Overall, operative success
was 93% with a multiglandular disease rate of 5%.
Conclusion
A high operative success rate for hyperfunctioning ectopic glands can be achieved
using localization studies and intraoperative parathyroid monitoring. Nevertheless,
surgeon judgment remains paramount in the operative direction of this patient population.
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Article info
Publication history
Accepted:
May 28,
2013
Identification
Copyright
© 2013 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
