Impact of complementary parathyroid scintigraphy and ultrasonography on the surgical management of hyperparathyroidism.

Abstract

An ongoing debate exists regarding the relative merits of full versus limited neck exploration in the surgical management of parathyroid adenomata. The aim of this study was to assess the impact of localization studies on the subsequent surgical management of hyperparathyroidism. The accuracy of complementary ultrasonography and 201TI/99mTc parathyroid subtraction scintigraphy in hyperparathyroidism was evaluated retrospectively during a 10-year period in patients referred for localization studies. Surgical and pathologic confirmation of the diagnosis was possible in 121 patients, and these data formed the basis of this study. Operative procedure, times, outcome, and complications were recorded. The sensitivity, specificity, and accuracy for combined scintigraphy and ultrasonography were 86%, 98%, and 96%, respectively. Limited neck exploration was performed in 61 of 121 patients, and 60 patients underwent full neck exploration. In primary hyperparathyroidism 59 of 105 patients underwent limited and 46 underwent full neck exploration with average operative times of 70 and 109 minutes, respectively. (p < 0.0001). Complications developed in five patients who underwent full neck exploration. Confident localization of parathyroid adenomata facilitated successful limited neck exploration in most of the patients, questioning the need for full neck exploration in all patients with primary hyperparathyroidism.