Computed tomography can guide focused exploration in select patients with primary hyperparathyroidism and negative sestamibi scanning.
BACKGROUND
The aim of this study was to analyze the utility of preoperative thin cut (2.5 mm) computed tomography (CT) in patients with primary hyperparathyroidism (PHPT) and negative sestamibi scans.


METHODS
A retrospective review of patients with PHPT was conducted from the prospective parathyroid registries of 2 tertiary referral centers. Of 482 patients, 63 with negative sestamibi scanning underwent thin cut CT of the neck and were included in the final analysis.


RESULTS
CT was 85% sensitive and 94% specific for correctly lateralizing the side(s) of diseased glands and 66% sensitive and 89% specific for predicting exactly the location of diseased glands. Sixty-six percent of patients underwent focused explorations, and 87% of patients underwent parathyroidectomy under local anesthesia. Pathology revealed a single adenoma in 83%, multigland disease in 14%, carcinoma in 1%, and no pathology in 2%. Average operative time was 73 minutes overall, but only 55 minutes in patients with precise CT localization (P = .02).


CONCLUSIONS
Thin cut CT is a helpful adjunct to preoperative workup in PHPT patients who have negative sestamibi localization and permits a focused neck exploration in a high percentage of those patients.
Harari
Avital
A
Divisions of Endocrine Surgery of Columbia University and Weill Cornell University Medical Centers of the New York Presbyterian Hospital, New York, NY, USA. ah2275@columbia.edu
Zarnegar
Rasa
R
Lee
James
J
Kazam
Elias
E
Inabnet
William B
WB
Fahey
Thomas J
TJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging* / Q000601:surgery*; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D011300:Preoperative Care; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012042:Registries; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi