title: Parathyroid surgery: correlation between pre-operative localization studies and surgical outcomes.
abstract: OBJECTIVE
  Pre-operative imaging techniques have enabled minimally invasive parathyroid surgery to supersede the traditional approach to hyperparathyroidism (HPT) surgery, which included cervical exploration. Cervical ultrasound (US) and sestamibi scan (MIBI) are commonly performed, but the results of these localization tests do not always match. This study correlated surgical outcomes with pre-operative localization findings, including matched positive US and MIBI studies, one positive study (US or MIBI), conflicting studies or negative results.
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  A hundred and sixty nine consecutive patients who underwent parathyroidectomy from January 2005 to December 2012.
  
  
  METHODS
  Correlation between surgical outcomes and pre-operative localization tests.
  
  
  RESULTS
  All patients (134F/35M, 59·6 ± 13·5 years of age) had primary HPT. US and MIBI localization studies matched in 76%, whereas 10·7% had positive MIBI only and 8·3% US only. Studies were negative in 3·6% and contradictory in 1·8%. Minimally invasive parathyroidectomy was performed in 87% of the matched group and 89% of the MIBI-only group. Surgical success rate, defined as postoperative normalization of calcium and PTH levels, was similar in patients with a single positive study (MIBI or US) vs double-matched studies (MIBI and US). Patients were followed up for 6 weeks. Overall, pathology was consistent with adenoma in 95%.
  
  
  CONCLUSIONS
  Parathyroidectomy success rate was similar in patients with primary HPT and MIBI-only or US-only positive localization studies compared to those with matched US/MIBI studies. The results support a clinical algorithm in which positive results from one imaging technique, either MIBI or US, are sufficient to refer a patient for parathyroid surgery.
authors.affiliation: Department of ENT, Head & Neck Surgery, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Ebner
authors.affiliation: Department of ENT, Head & Neck Surgery, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Garti-Gross
authors.affiliation: Department of ENT, Head & Neck Surgery, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Margulis
authors.affiliation: Department of Medicine E, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Yair
authors.initials: Y
authors.lastname: Levy
authors.affiliation: Department of Endocrinology, Meir Medical Center, Kfar Saba, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Nabrisky
authors.affiliation: Department of ENT, Head & Neck Surgery, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Dov
authors.initials: D
authors.lastname: Ophir
authors.affiliation: Department of Medicine E, Meir Medical Center, Kfar Saba, Israel.|Department of Endocrinology, Meir Medical Center, Kfar Saba, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Pnina
authors.initials: P
authors.lastname: Rotman-Pikielny
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000601:surgery; D016105:Parathyroidectomy / Q000706:statistics & numerical data*; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D014463:Ultrasonography
chemical_list: D017256:Technetium Tc 99m Sestamibi