[Minimal invasive surgery for pHPT--which patients will profit?].
BACKGROUND
Standard for treatment of pHPT has been the exploration of the neck and extirpation of the macroscopic identified adenoma for a long time. Since the Quick-PTH-Assay is available as intraoperative control of success, it is possible to extirpate a preoperativeley localized adenoma without identifying the normal parathyroid glands. Since the accuracy of the preoperative localization is essential for a minimally invasive or endoscopic procedure, we analyzed retrospectively the accuracy of ultrasound and mibiscan of our patients, operated due to pHPT in our facility.


METHODS
Between 1995 and 2002 119 patients were operated due to HPT in our facility. Sensitivity, specificity, positive- and negative-predictive value for diagnosis and correct localisation of a singular adenoma by ultrasound and/or mibiscan were determined.


RESULTS
We found a singular adenoma in 94 patients, a carcinoma in 1 patient, 6-times a double-adenoma and in 18 cases a hyperplasia of all parathyroid glands. Sensitivity, specificity, positive- and negative-predictive value for diagnosis and correct localisation of a singular adenoma were 52 %, 41 %, 60 % and 27 % rsp., when the results of mibiscan and ultrasound were used.


CONCLUSIONS
Related to the preoperative imaging, a single gland exploration and extirpation would have been possible in 70 % of our patients with pHPT. However, in 40 % of these patients the 100 % reliable Quick-PTH-Assay would have shown, that the adenoma has not been removed successfully in the first attempt.
Schiffmann
L
L
Chirurgische Klinik I, Universitätsklinikum Benjamin Franklin, Berlin. Schiffmann@medizin.fu-berlin.de
Mann
B
B
Hotz
H
H
Buhr
H J
HJ
D000236:Adenoma / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D014463:Ultrasonography
D010281:Parathyroid Hormone; D017256:Technetium Tc 99m Sestamibi