[Reappraisal of T1-Tc scanning in the preoperative localization of hyperfunctioning parathyroid glands]

Preoperative localization for hyperfunctioning parathyroid glands remains a problem in clinical parathyroid surgery. From January 1984 to August 1986, a total of 16 patients with the diagnosis of primary hyperparathyroidism (14) or secondary hyperparathyroidism (2) received preoperative T1-Tc image studies to localize the hyperfunctioning parathyroid glands. All the patients underwent surgery as soon as the diagnoses had been confirmed, and were cured. During surgery, bilateral neck explorations and parathyroid biopsies were routinely performed. All the adenomas were removed, and half of the hyperplastic parathyroid gland was preserved in patients with 4 enlarged hyperplastic glands (3 1/2 hyperplastic glands were removed). The results of the T1-Tc scans correlated with the pathological and operative findings. A hyperfunctioning parathyroid gland with a positive scan was considered as a true positive; a hyperfunctioning parathyroid gland with a negative scan was considered a false negative; normal parathyroid glands with negative scans were considered true negatives; while positive scans without hyperfunctioning parathyroids were counted as false positives. The sensitivity, specificity and accuracy of this localization tool were thereby calculated. On at least 6 months of follow-up, all the patients remained normocalcemic. T1-Tc scanning showed a total of 20 positive images: 6 images were proved to be enlarged parathyroid adenomas, 13 images to be hyperplastic glands and the other one to be thyroid nodule. Also, 2 adenomas, 19 hyperplastic glands and 22 normal parathyroid glands not visualized by T1-Tc scanning were found on exploration. Eight of the 14 patients with primary hyperparathyroidism included 1 adenoma in each patient, 3 normal glands in 6 patients and 2 normal glands in the other 2 patients.(ABSTRACT TRUNCATED AT 250 WORDS)