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Stepwise Approach for Parathyroid Localisation in Primary Hyperparathyroidism.
Vijay Korwar1, Fernando Yuen Chang2, Ella Teasdale2
1Department of Transplant and Endocrine Surgery, General Surgery North Bristol NHS Trust, Southmead Hospital, Brunel Building, Level 3, Gate 38, Room 2, Westbury-on-Trym, Bristol, BS10 5NB, UK. vkorwar@gmail.com.
World Journal of Surgery
|November 13, 2019
Summary
Ultrasound is a highly sensitive first-line imaging tool for primary hyperparathyroidism (PHPT) localization, guiding selective parathyroidectomy. Other imaging like sestamibi and SPECT CT are reserved for complex cases.
Area of Science:
- Endocrinology
- Surgical Oncology
- Radiology
Background:
- Primary hyperparathyroidism (PHPT) is common in surgical practice.
- Localization studies have shifted treatment from bilateral neck exploration to selective parathyroidectomy.
- Ultrasound is the first-line imaging, but its sensitivity is operator-dependent.
Purpose of the Study:
- To evaluate the sensitivity and accuracy of pre-operative imaging modalities for localizing abnormal parathyroid glands in PHPT patients.
- To compare ultrasound (US), 99mTc-sestamibi, and SPECT CT in identifying hyperfunctioning parathyroid glands.
Main Methods:
- 250 consecutive PHPT patients undergoing parathyroidectomy were studied.
- Pre-operative imaging included neck ultrasound (n=249), 99mTc-sestamibi (n=237), and SPECT CT (n=198).
- Sensitivity, positive predictive value (PPV), and accuracy were calculated against surgical and pathology findings.
Main Results:
- Ultrasound showed 80.80% sensitivity, 92.35% PPV, and 75.73% accuracy.
- Sestamibi had 71.82% sensitivity, 94.61% PPV, and 69.00% accuracy.
- SPECT CT demonstrated 70.21% sensitivity, 97.78% PPV, and 69.11% accuracy. Overall success rate was 94.8%.
Conclusions:
- Ultrasound by an experienced sonographer is highly sensitive for localizing abnormal parathyroid glands in PHPT.
- Ultrasound can be the primary and sole imaging investigation for most patients.
- Sestamibi, SPECT CT, and other tests are best reserved for cases with negative US, failed primary surgery, or recurrence.
