Detectability and surgical outcomes in parathyroid surgery - a single-centre experience

Area of Science:

• Endocrinology
• Nuclear Medicine
• Radiology

Background:

• The incidence of primary hyperparathyroidism and parathyroid adenoma removal surgeries is rising.
• Effective preoperative localization of parathyroid adenomas is crucial for successful surgical outcomes.
• Intraoperative monitoring of parathyroid hormone (PTH) is a key factor in parathyroid surgery.

Purpose of the Study:

• To evaluate factors influencing the preoperative detectability of parathyroid adenomas.
• To assess the impact of imaging modalities on surgical outcomes in primary hyperparathyroidism.
• To investigate the role of vitamin D and adenoma characteristics in lesion localization.

Main Methods:

• Retrospective study of 117 patients undergoing parathyroidectomy with intraoperative PTH monitoring.
• Preoperative localization using sestamibi scan, ultrasound, and CT fusion.
• Assessment of calcium, PTH, specimen weight, and vitamin D levels.

Main Results:

• Sestamibi scan sensitivity was 92%, and ultrasound sensitivity was 80% for adenoma detection.
• Sestamibi scans were more accurate in patients with low vitamin D (p=0.037) and heavier adenomas (p<0.001).
• 97% of patients achieved biochemical cure post-surgery.

Conclusions:

• Accurate preoperative localization, particularly with sestamibi scans, facilitates targeted parathyroidectomy and improves surgical success.
• Low vitamin D and heavier adenomas are associated with improved sestamibi scan detectability.
• Further research is needed to clarify the role of vitamin D in parathyroid adenoma localization.