Results of surgery for sporadic primary hyperparathyroidism in patients with preoperatively negative sestamibi scintigraphy and ultrasound.
OBJECTIVE
The purpose of this study is to investigate the results of first-time surgery for sporadic primary hyperparathyroidism (pHPT) in patients with preoperatively negative sestamibi scintigraphy and ultrasound.


METHODS
Data were gathered prospectively in a multicenter database for quality control in parathyroid surgery. Between 2004 and 2008, 3,158 patients underwent first-time surgery for sporadic pHPT. A total of 984 patients were subjected to preoperative localization with ultrasound and sestamibi scintigraphy, and in 173 patients, both investigations were negative. Intraoperative findings and early outcome are reported.


RESULTS
One hundred and fifty-five of 173 patients underwent bilateral neck exploration. The median weight of excised parathyroid tissue was 350 mg. In 23 patients (13.3%), the exploration was negative. A total of 112 patients (64.7%) had a histological diagnosis of parathyroid adenoma and 38 patients (22%) had multiglandular disease. Six weeks after operation, 164 patients were available for analysis, and 30 patients (18%) had persistent pHPT. The risk for persistent pHPT increased for patients with few intraoperatively identified (p = 0.001) and excised (p = 0.024) parathyroid glands. Patients operated with intraoperative parathyroid hormone (iOPTH) had lower risk for persistent pHPT 7/79 (9%) compared with 23/85 patients (27%) operated without iOPTH (p = 0.003).


CONCLUSIONS
Negative localization with sestamibi and ultrasound in pHPT infers a highly selected patient population with small parathyroid adenomas, an alarmingly high rate of negative exploration, and an increased risk for persistent disease. The use of iOPTH influences cure rate favorably.
Department of Surgery, Skåne University Hospital-Lund, 221 85 Lund, Sweden. anders.bergenfelz@med.lu.se
Anders O J
AO
Bergenfelz
Göran
G
Wallin
Svante
S
Jansson
Håkan
H
Eriksson
Hans
H
Mårtensson
Peer
P
Christiansen
Eva
E
Reihnér
D000236:Adenoma / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000175:diagnosis / Q000601:surgery; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000175:diagnosis; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D016105:Parathyroidectomy; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis; D011300:Preoperative Care; D011877:Radionuclide Imaging; D012086:Reoperation; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D014463:Ultrasonography
D010281:Parathyroid Hormone; D017256:Technetium Tc 99m Sestamibi