[The value of preoperative localization studies in primary hyperparathyroidism]

Area of Science:

• Endocrinology
• Surgical Oncology
• Nuclear Medicine

Background:

• Bilateral neck exploration is the standard surgical approach for primary hyperparathyroidism.
• Preoperative localization is not mandatory for bilateral exploration but is essential for minimally invasive procedures.
• Minimally invasive surgery is indicated for localized single-gland parathyroid disease.

Purpose of the Study:

• To evaluate the role of preoperative localization techniques in planning first-time minimally invasive exploration for primary hyperparathyroidism.
• To assess the accuracy of combined (99m)Tc-SestaMIBI scintigraphy and ultrasound in localizing parathyroid adenomas.
• To determine the utility of advanced imaging modalities like CT and MRI in preoperative localization.

Main Methods:

• Retrospective analysis of preoperative localization studies for primary hyperparathyroidism.
• Utilized (99m)Tc-SestaMIBI scintigraphy and ultrasound for parathyroid adenoma localization.
• Compared the efficacy of scintigraphy/ultrasound with computerized tomography (CT) and magnetic resonance imaging (MRI).

Main Results:

• The combination of (99m)Tc-SestaMIBI scintigraphy and ultrasound achieved correct localization in 86% of single-gland parathyroid diseases.
• Multiple gland disease could only be predicted in isolated cases.
• CT and MRI did not significantly improve localization results compared to scintigraphy and ultrasound.

Conclusions:

• Preoperative localization is vital for planning minimally invasive surgery in primary hyperparathyroidism.
• Combined sestamibi scintigraphy and ultrasound offer high accuracy for identifying single-gland parathyroid adenomas.
• Surgery for persistent or recurrent hyperparathyroidism necessitates positive preoperative localization findings.