Impact of localization studies and clinical scenario in patients with hyperparathyroidism being evaluated for reoperative neck surgery
Related Experiment Video
Updated: May 26, 2026
Establishment of a Simple and Effective Rat Model for Intraoperative Parathyroid Gland Imaging
Published on: August 17, 2022
Joyce J Shin1, Mira Milas, Jamie Mitchell
1Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, 9500 Euclid Ave, Ste F20, Cleveland, OH 44195, USA. shinj2@ccf.org
Background:
Previous studies have focused on the success of localization studies (LSs) in patients undergoing reoperative parathyroid surgery; however, patients who did not undergo reexploration surgery have been excluded from analysis. In addition, the concept of whether clinical scenario (CS) suggests single- vs multiple-gland disease in reoperative strategy is often underemphasized.
Objective:
To evaluate how LSs and CS direct operative strategy in patients being considered for reexploration.
Design:
Retrospective review of a prospective database.
Setting:
Tertiary referral center.
Patients:
Two hundred three patients with hyperparathyroidism who underwent previous neck surgery. The CS stratified patients as candidates for single- or multiple-site exploration (or unknown).
Main Outcome Measure:
Ability of CS and LSs to direct successful reexploration.
Results:
Of 203 patients, 27 were not explored owing to nonlocalizing studies. Of the remaining 176 patients, LSs accurately guided reexploration in 85%. However, when including the 27 nonexplored patients, the success of LSs decreased to 73%. The cure rate in reoperated patients was 96% but was reduced to 83% when including nonexplored patients. Of the reoperated patients, 83% had single-site disease and 17% had multiple-site disease. The positive predictive value of LSs in predicting single- or multiple-site disease was 92% and 73%, respectively. However, when stratified by CS, the positive predictive value increased to 95% for single-site disease and to 100% for multiple-site disease.
Conclusions:
Failure to cure patients was 4 times more likely to be due to nonlocalizing studies than to a failed reexploration. Stratification by CS was useful in the interpretation of LSs and in determining the most accurate reoperative approach.
