title: Surgery for primary hyperparathyroidism in patients with preoperatively negative sestamibi scan and discordant imaging studies: the usefulness of intraoperative parathyroid hormone monitoring.
abstract: The aim of this study was to evaluate the impact of intraoperative parathyroid hormone (PTH) monitoring on surgical strategy, intraoperative findings, and outcome in patients with negative sestamibi scintigraphy and with discordant imaging studies. We divided our 175 patients into 3 groups: group A was methoxyisobutylisonitrile (MIBI)-positive and ultrasonography positive and was concordant (114 patients), group B was MIBI-positive and ultrasonography-negative (50 patients), and group C was MIBI-and ultrasonography-negative (11 patients). The overall operative success was 99.12% in group A, 98% in group B, and 90.91% in group C, with an incidence of multiglandular disease of 3.5% in group A, 12% in group B, and 9.09% in group C. Intraoperative PTH monitoring changed the operative management in 2.63% of patients in group A and 14% in group B. The use of intraoperative PTH achieves to obtain excellent results in the treatment of primary hyperparathyroidism in high-volume centers, even in the most difficult cases, during MIBI-negative and discordant preoperative imaging studies.
authors.affiliation: Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
authors.forename: Pietro Giorgio
authors.initials: PG
authors.lastname: Calò
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pisano
authors.forename: Giulia
authors.initials: G
authors.lastname: Loi
authors.forename: Fabio
authors.initials: F
authors.lastname: Medas
authors.forename: Alberto
authors.initials: A
authors.lastname: Tatti
authors.forename: Stefano
authors.initials: S
authors.lastname: Piras
authors.forename: Angelo
authors.initials: A
authors.lastname: Nicolosi
keywords: intraoperative PTH; parathyroidectomy; primary hyperparathyroidism; sestamibi scintigraphy