Primary hyperparathyreosis: Is concordant sonography and scintigraphy really so important?

Abstract

Abstract:Background: In primary hyperparathyreosis, US and scintigraphy are the most usual preoperative localization methods for detection of parathyroid adenomas or hyperplasia. Results: 88 (80 female) patients were detected. Unilateral neck exploration was performed in 43 patients (48.9 %) and bilateral exploration in 45 patients (51.1 %). The cure rate was 97.6 %. None case of parathyroid hyperplasia was detected, there were 2 cases of duplex adenoma. For left/right and quadrant localization, sensitivity of US was 71.05 % and 55.07 %, of scintigraphy 95.77 % and 88.71 %, and in concordant imaging 97.67 % and 96.77 %. Analogically, PPV was: US 91.53 % and 76.00 %, scintigraphy 87.18 % and 74.32 %, concordant imaging 93.33 % and 81.08 %. Only US sensitivity was signifi cantly lower, all other differences showed no statistical signifi cance. Conclusion: Our data showed low sensitivity but a high positive predictive value of ultrasonography and a high diagnostic value of scintigraphy. Sensitivity and the positive predictive value of concordant localization showed no signifi cant difference, compared to scintigraphy. The routine need for concordance for parathyroid adenoma localization appears dubious, however, its value for prediction of multiglandular disease remains important for protocols that do not apply peroperative localization (Tab. 2, Ref. 35 Acknowledgments: This text is an original work based upon authors' experience and data. The text and none of its parts has never been published before.

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

“…Combinations of various diagnostic imaging modalities, especially MIBI and US, may improve the accuracy of SA diagnosis [3] , [12] , [13] ; however, the possibility remains of misdiagnosing MGD as SA. Indeed, for patients with a negative MIBI scan, preoperative localization of the affected gland and exclusion of MGD is incredibly difficult, with the diagnostic accuracy of US in patients with a negative MIBI scan reported to be 43% in a retrospective study on a large patient cohort [14] .…”