title: Preoperative localizing studies for initial parathyroidectomy in MEN1 syndrome: is there any benefit?
abstract: BACKGROUND
  The objective of the present study was to evaluate the utility of preoperative localizing studies in patients with MEN1 undergoing initial bilateral neck exploration (BNE) and parathyroidectomy for pHPT.
  
  
  METHODS
  We performed a retrospective analysis of patients diagnosed with MEN1 who underwent initial parathyroidectomy between December 1993 and December 2010. Results of preoperative localizing studies were compared with intraoperative findings and outcome.
  
  
  RESULTS
  Sixty patients with MEN1 (32 females and 28 males) underwent initial subtotal parathyroidectomy. The median age at the time of surgery was 33 years (range: 13-78 years). Fifty-three patients had one or more positive localizing study results. Neck ultrasonography, sestamibi scan, parathyroid protocol computed tomography scan, and neck and mediastinum magnetic resonance imaging were performed in 93, 91, 32, and 19% of patients, respectively. Fifty-three patients (88%) had cervical thymectomy. Twenty patients had 24 ectopic parathyroid glands; 18 glands were in the thymus (75%). Preoperative localizing studies identified 9 of 24 ectopic parathyroid glands (38%), including 4 ectopic glands outside the thymus in 4 patients (7%); 3 were detected by ultrasonography. There were no supernumerary glands identified on preoperative localizing studies.
  
  
  CONCLUSIONS
  In patients with MEN1, preoperative localizing studies identified a subset of ectopic glands (38%). Preoperative localizing studies may alter the operative approach in 7% of patients. Ultrasonography can detect most ectopic parathyroid glands outside thymus. This suggests that routine preoperative localizing studies to identify ectopic and supernumerary enlarged parathyroid glands is not useful in the majority of patients with MEN1 undergoing bilateral neck exploration and subtotal parathyroidectomy with cervical thymectomy.
authors.affiliation: Endocrine Oncology Section, Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, MSC1201 Rm 3-3940, Bethesda, MD 20892-1201, USA. niluboln@mail.nih.gov
authors.forename: Naris
authors.initials: N
authors.lastname: Nilubol
authors.forename: Lee
authors.initials: L
authors.lastname: Weinstein
authors.forename: William F
authors.initials: WF
authors.lastname: Simonds
authors.forename: Robert T
authors.initials: RT
authors.lastname: Jensen
authors.forename: Giao Q
authors.initials: GQ
authors.lastname: Phan
authors.forename: Marybeth S
authors.initials: MS
authors.lastname: Hughes
authors.forename: Steven K
authors.initials: SK
authors.lastname: Libutti
authors.forename: Stephen
authors.initials: S
authors.lastname: Marx
authors.forename: Electron
authors.initials: E
authors.lastname: Kebebew
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002828:Choristoma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000209:etiology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D018761:Multiple Endocrine Neoplasia Type 1 / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D009333:Neck / Q000000981:diagnostic imaging; D010280:Parathyroid Glands / Q000000981:diagnostic imaging; D010282:Parathyroid Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D016105:Parathyroidectomy; D049268:Positron-Emission Tomography; D011300:Preoperative Care / Q000379:methods*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi