[Usefulness of preoperative location studies in the initial surgical intervention in primary hyperparathyroidism]

The aim of the study was to assess whether preoperative localization is helpful in improving the outcome of initial surgery of primary hyperparathyroidism (PHPT).

Retrospective review of 100 patients treated surgically for PHPT. In 30 cases (group I) 3 or 4 localization studies were performed from the following: ultrasonography (US), computed tomography (CT), thallium-technetium substraction scintigraphy (TTS), and technetium 99m-sestamibi scanning (MIBI). Thirty one patients (group II) were operated without previous localization. Sensitivity and false localization rate of image studies were calculated, and cure and surgical complication rates were compared in both groups.

Both groups were similar in mean age (56.2 vs 52.2 years), serum calcium (12.3 vs 12.1 mg/dl), intact PTH levels (304 vs 254 pg/ml), pathology (26 adenomas, 3 hyperplasias and 1 carcinoma vs 27 adenomas, 3 hyperplasias and 1 carcinoma) and additional clinical and biochemical data. The highest sensitivity technique was for MIBI (62.5%). The highest false localization rate was for CT (27.6%). No significative differences were found between groups I and II for the cure rate (90% vs 87.1%) or surgical complications (3.3% vs 3.2%).

In our series of patients with primary hyperparathyroidism preoperative localization studies display low sensitivity and estimable false localization rate. These techniques increment cost and don't improve success rate of initial surgery in PHPT. Therefore, we believe its performance controversial.