[First cervicotomy for primary hyperparathyroidism. Argument against preoperative imaging]

The sensitivity of various pre-operative imaging methods for enlarged parathyroid glands ranges between 40 and 80%. These dismal results can be explained by the limits of resolution and uneven specificity of the methods and by parathyroid ectopias. Conversely, in primary hyperparathyroidism (PHT), multiple gland enlargement occurs in 12-30% of cases and therefore, even a positive imaging study can overlook a second enlarged gland. A prospective study conducted in 34 patients, all successfully operated, confirmed the lack of value of pre-operative imaging before a first neck exploration, with a sensitivity of 33 to 80%, depending on the method.