Ultrasound and Scintigraphy for Preoperative Localization in Primary Hyperparathyroidism: A Single-Center Experience

Area of Science:

• Endocrinology
• Surgical Oncology
• Medical Imaging

Background:

• Primary hyperparathyroidism (PHPT) is an endocrine disorder often caused by parathyroid adenomas.
• Surgical removal is the standard treatment for symptomatic PHPT.
• Preoperative imaging, including ultrasound (US) and sestamibi parathyroid scintigraphy (PS), aids surgical planning.

Purpose of the Study:

• To evaluate the utility of US and PS for preoperative localization in PHPT surgery.
• To assess the impact of these imaging modalities on surgical cure rates.

Main Methods:

• Retrospective review of 297 PHPT surgeries over nine years.
• Analysis of US and PS sensitivity, specificity, PPV, and NPV.
• Statistical analysis of imaging findings and cure rates, controlling for confounding factors.

Main Results:

• US showed high sensitivity (79.4%) and specificity (64.3%) for lesion localization.
• PS demonstrated lower specificity (48.3%) compared to US.
• US status was a significant predictor of surgical cure (OR 4.47, p=0.001), while PS alone was not.

Conclusions:

• Image-guided focused parathyroidectomy improves cure rates in PHPT.
• US is a reliable predictor of cure and aids in planning focused parathyroidectomy.
• PS as an adjunct to US did not significantly improve cure rates in this study.
• Further imaging like 4D CT may benefit high-risk patients undergoing reoperation or with unclear initial imaging findings.