Ultrasound-guided unilateral neck exploration for sporadic primary hyperparathyroidism: is it worthwhile?

Area of Science:

• Endocrinology
• Surgical Oncology
• Radiology

Background:

• The efficacy of preoperative localization tests and surgical approaches for primary hyperparathyroidism (PHP) is debated.
• This study evaluates the role of preoperative ultrasound (US) and surgical management strategies for sporadic PHP.

Purpose of the Study:

• To assess the diagnostic performance of preoperative ultrasound in identifying parathyroid adenomas.
• To compare the outcomes of selective unilateral neck exploration (UNE) versus routine bilateral neck exploration (BNE) for sporadic PHP.

Main Methods:

• Retrospective analysis of 72 patients with sporadic PHP undergoing initial neck exploration between 1990 and 1995.
• Preoperative ultrasound (US) performed by an experienced radiologist.
• Comparison of outcomes between US-guided UNE and BNE approaches.

Main Results:

• US demonstrated 80% sensitivity, 100% specificity, and 90% accuracy in localizing parathyroid adenomas.
• Comparable success rates were observed: BNE (97%) and UNE (93%), with low morbidity for both.
• Failures in UNE were attributed to missed contralateral adenomas, highlighting the need for experienced radiologists and low multiglandular disease (MGD) incidence.

Conclusions:

• Preoperative US is a valuable tool for guiding surgical management of sporadic PHP.
• Both BNE and UNE achieve high success rates, with UNE being feasible under specific conditions (experienced radiologist, low MGD).
• An experienced surgeon is the sole prerequisite for the 'gold standard' bilateral approach.