Evaluation of the minimally invasive parathyroidectomy in patients with primary hyperparathyroidism: A retrospective cohort study

Abstract

IntroductionAn accurate differential diagnosis between single adenoma (SA) and multiglandular disease (MGD) remains difficult in Technetium-99m sestamibi scintigraphy (MIBI)-negative patients with primary hyperparathyroidism (PHPT). The aim of the present study was to evaluate the minimally invasive parathyroidectomy (MIP) in patients with PHPT.MethodsClinical records of 48 patients who underwent neck exploration between November 2002 and June 2012 in Kochi Medical School Hospital were reviewed retrospectively to identify candidates that underwent for MIP which was defined as the selective removal of a SA using less invasive surgery.ResultsThe preoperative detection rate of lesions using ultrasonography, MIBI, computed tomography, and magnetic resonance imaging was 90%, 83%, 76%, and 55%, respectively. Although all 39 patients in the MIBI-positive group were diagnosed with an SA and subsequently underwent curative MIP, 3 patients in MIBI-negative group (n = 6) were MGD, who underwent neck exploration. Preoperative mean intact parathyroid hormone (419 pg/ml vs. 149 pg/ml; P < 0.01) and alkaline phosphatase levels (746 U/l vs. 277 U/l; P < 0.01) were significantly higher in the SA than MGD group.ConclusionsIn MIBI-negative patients with indications for surgery, MIP should not be carried out without a clear localization of SA, or in MGD.

Pre-operative Localisation of the Parathyroid Glands in Secondary Hyperparathyroidism: A Retrospective Cohort Study

“…The accuracy of each modality at identifying the standard bilateral upper and lower parathyroid glands was between 42.7% and 60.0%, which was lower than the accuracies of their different combinations. Hence, using one imaging modality is not beneficial for evaluating the location of parathyroid glands, and in particular, the lower diagnostic accuracy of MIBI scans compared with the diagnostic accuracies of CT and US implies that, rather than using MIBI scanning as the main diagnostic imaging modality for pre-operative evaluations of primary HPT, it should be used as an auxiliary imaging modality 24 . Regarding the assessment of the combinations of imaging modalities, the combination of CT, US, and MIBI scanning showed a significantly higher accuracy than other combinations.…”