Maximizing outcomes while minimizing exploration in hyperparathyroidism using localization tests.
OBJECTIVE
Preoperative localization (ultrasonography and scintigraphy) can be used to limit operative exploration in primary hyperparathyroidism while providing a high rate of success.


METHODS
Prospective cohort analysis of 3 types of exploration (1-gland, unilateral, or 4-gland), as directed by localization.


RESULTS
In 185 consecutive patients who underwent operations, the final diagnoses were solitary adenoma in 87% and multigland disease in 13%. Ultrasonography (75%) and scintigraphy (83%) demonstrated an enlarged parathyroid gland and, together with operative findings, resulted in 61 1-gland, 63 unilateral, and 61 4-gland explorations, with an initial success rate of 96% and an ultimate success rate of 99%. Limiting exploration resulted in a significant decrease in operative time and hospitalization.


CONCLUSIONS
Localization can limit exploration with success.
Department of Surgery, Virginia Mason Medical Center, Seattle, WA 98111, USA. john.ryan@vmmc.org
John A
JA
Ryan
Faye T
FT
Lee
D000236:Adenoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003949:Diagnostic Techniques, Surgical; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011877:Radionuclide Imaging; D013959:Thyroid Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D013964:Thyroid Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D014463:Ultrasonography