Parathyroid surgery: separating promise from reality.
We set out to determine the accuracy in predicting the success of biochemical and localizing studies for use in a minimally invasive parathyroidectomy. Preoperative sestamibi scans, intraoperative gamma-probe examinations, and intraoperative PTH (IOPTH) monitoring were performed on a prospective cohort of patients. Seventy-one patients were included in the study. Of the 59 patients (83%) with primary HPT, adenoma localization by sestamibi scanning was correct in 95% with solitary adenomas, but was correct in only 25% of the 14 patients with multiple adenomas. In patients with secondary and tertiary disease, sestamibi scanning incorrectly identified a single hot spot in 64% of cases. In no case of hyperplasia was the probe useful in locating other glands after a single gland was removed. IOPTH was accurate in 78% of patients with primary disease and in only 45% of patients with nonprimary disease. A minimal approach can be considered in a select group of patients that does not have familial primary HPT, secondary or tertiary disease, coexisting thyroid pathology, or an equivocal sestamibi scan. Only patients with a positive single hot spot on sestamibi scan can be considered candidates. Using this criteria only 64% of all patients with hyperparathyroidism are candidates for a minimally invasive approach. The combination of a solitary hot spot on sestamibi scan and a fall in IOPTH allows the surgeon to make the correct decision regarding the need to convert to a bilateral approach in 93% of these selected patients.
Perrier
Nancy D
ND
Department of Surgery, University of California, San Francisco/Mount Zion Medical Center, San Francisco, California 94143-1674, USA. nperrier@wfubmc.edu
Ituarte
Philip H G
PH
Morita
Eugene
E
Hamill
Timothy
T
Gielow
Robert
R
Duh
Quan-Yang
QY
Clark
Orlo H
OH
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005544:Forecasting; D015902:Gamma Cameras; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010279:Parathyroid Diseases / Q000097:blood / Q000175:diagnosis; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D011446:Prospective Studies; D017256:Technetium Tc 99m Sestamibi
D010281:Parathyroid Hormone; D017256:Technetium Tc 99m Sestamibi