title: Preoperative sestamibi localization combined with intraoperative parathyroid hormone assay predicts successful focused unilateral neck exploration during surgery for primary hyperparathyroidism.
abstract: A retrospective review of 54 cases of primary hyperparathyroidism operated upon by five general surgeons at Santa Barbara Cottage Hospital between March 1998 and March 2001 was performed to determine whether positive preoperative sestamibi localization (PSL) of a solitary adenoma combined with intraoperative parathyroid hormone assay (IOPHA) could predict successful focused unilateral neck exploration. A solitary adenoma was found in each of 50 patients (93%). PSL for solitary adenomas had an accuracy of 87 per cent, positive predictive value (PPV) of 96 per cent, sensitivity of 90 per cent, and specificity of 50 per cent. Forty-five patients (83%) achieved a 50 per cent reduction in IOPHA at 10 minutes after excision of a solitary adenoma for an accuracy of 85 per cent, PPV of 97 per cent, sensitivity of 88 per cent, and specificity of 50 per cent. All patients remain eucalcemic. The combination of PSL and IOPHA resulted in a PPV of 97.5 per cent and a sensitivity of 100 per cent. From these data we conclude that a focused unilateral neck exploration could have been performed successfully in 78 per cent of the cases.
authors.affiliation: Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California, USA.
authors.forename: Pringl
authors.initials: P
authors.lastname: Miller
authors.forename: Amanda
authors.initials: A
authors.lastname: Kindred
authors.forename: Daniel
authors.initials: D
authors.lastname: Kosoy
authors.forename: David
authors.initials: D
authors.lastname: Davidson
authors.forename: Hewitt
authors.initials: H
authors.lastname: Lang
authors.forename: Kenneth
authors.initials: K
authors.lastname: Waxman
authors.forename: James
authors.initials: J
authors.lastname: Dunn
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Latimer
mesh_terms: D000236:Adenoma / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D016105:Parathyroidectomy; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi