title: Impact of localization studies and clinical scenario in patients with hyperparathyroidism being evaluated for reoperative neck surgery.
abstract: BACKGROUND
  Previous studies have focused on the success of localization studies (LSs) in patients undergoing reoperative parathyroid surgery; however, patients who did not undergo reexploration surgery have been excluded from analysis. In addition, the concept of whether clinical scenario (CS) suggests single- vs multiple-gland disease in reoperative strategy is often underemphasized.
  
  
  OBJECTIVE
  To evaluate how LSs and CS direct operative strategy in patients being considered for reexploration.
  
  
  METHODS
  Retrospective review of a prospective database.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Two hundred three patients with hyperparathyroidism who underwent previous neck surgery. The CS stratified patients as candidates for single- or multiple-site exploration (or unknown).
  
  
  METHODS
  Ability of CS and LSs to direct successful reexploration.
  
  
  RESULTS
  Of 203 patients, 27 were not explored owing to nonlocalizing studies. Of the remaining 176 patients, LSs accurately guided reexploration in 85%. However, when including the 27 nonexplored patients, the success of LSs decreased to 73%. The cure rate in reoperated patients was 96% but was reduced to 83% when including nonexplored patients. Of the reoperated patients, 83% had single-site disease and 17% had multiple-site disease. The positive predictive value of LSs in predicting single- or multiple-site disease was 92% and 73%, respectively. However, when stratified by CS, the positive predictive value increased to 95% for single-site disease and to 100% for multiple-site disease.
  
  
  CONCLUSIONS
  Failure to cure patients was 4 times more likely to be due to nonlocalizing studies than to a failed reexploration. Stratification by CS was useful in the interpretation of LSs and in determining the most accurate reoperative approach.
authors.affiliation: Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, 9500 Euclid Ave, Ste F20, Cleveland, OH 44195, USA. shinj2@ccf.org
authors.forename: Joyce J
authors.initials: JJ
authors.lastname: Shin
authors.forename: Mira
authors.initials: M
authors.lastname: Milas
authors.forename: Jamie
authors.initials: J
authors.lastname: Mitchell
authors.forename: Eren
authors.initials: E
authors.lastname: Berber
authors.forename: Louis
authors.initials: L
authors.lastname: Ross
authors.forename: Allan
authors.initials: A
authors.lastname: Siperstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000379:methods*; D011183:Postoperative Complications / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone; D017256:Technetium Tc 99m Sestamibi