title: Retrospective evaluation of the pre- and postoperative factors influencing the sensitivity of localization studies in primary hyperparathyroidism.
abstract: BACKGROUND
  Over the last decades, mini-invasive surgery has become increasingly common for treatment of primary hyperparathyroidism; such approach requires preoperative localization of a suspected parathyroid adenoma. Neck ultrasound (US) and technetium-99 m sestamibi (MIBI) scan are the main imaging studies used for this purpose. The aim of the present study is to evaluate what pre- and post-operative factors may alter the reliability of localization studies.
  
  
  METHODS
  A retrospective analysis on 212 patients with preoperative diagnosis of primary hyperparathyroidism was conducted. Data collected included demographic data, preoperative workup, operative findings and follow-up. Univariate logistic regression was performed on pre- and postoperative variables.
  
  
  RESULTS
  US sensitivity was 62.4% and MIBI sensitivity 78.9%. Cure rate after parathyroidectomy was 98.1%. Univariate logistic regression demonstrated that US sensitivity was impaired by lower levels of serum calcium (p < 0.0001), multi-gland disease (p = 0.011) and co-existence of thyroid disease (p = 0.001); MIBI sensitivity was impaired by lower levels of serum calcium (p = 0.001) and multi-gland disease (p < 0,0001).
  
  
  CONCLUSIONS
  Mild hypercalcaemia, multi-gland disease and co-existing thyroid disease are the main factors affecting sensitivity of preoperative imaging studies. In such patients a mini-invasive approach is possible but the use of intraoperative PTH monitoring is mandatory to reduce the risk of unsuccessful surgery.
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S. S. 554, Bivio Sestu, 09042 Monserrato (CA), Italy. Electronic address: fabiomedas@gmail.com.
authors.forename: Fabio
authors.initials: F
authors.lastname: Medas
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S. S. 554, Bivio Sestu, 09042 Monserrato (CA), Italy. Electronic address: enricoerdas@medicina.unica.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Erdas
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S. S. 554, Bivio Sestu, 09042 Monserrato (CA), Italy. Electronic address: alex1283@tiscali.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Longheu
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S. S. 554, Bivio Sestu, 09042 Monserrato (CA), Italy. Electronic address: dr.lucagordini@gmail.com.
authors.forename: Luca
authors.initials: L
authors.lastname: Gordini
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S. S. 554, Bivio Sestu, 09042 Monserrato (CA), Italy. Electronic address: gpisano@unica.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pisano
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S. S. 554, Bivio Sestu, 09042 Monserrato (CA), Italy. Electronic address: nicolosi@unica.it.
authors.forename: Angelo
authors.initials: A
authors.lastname: Nicolosi
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S. S. 554, Bivio Sestu, 09042 Monserrato (CA), Italy. Electronic address: pgcalo@unica.it.
authors.forename: Pietro Giorgio
authors.initials: PG
authors.lastname: Calò
mesh_terms: D000236:Adenoma / Q000150:complications / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000150:complications / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009333:Neck / Q000000981:diagnostic imaging; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D016105:Parathyroidectomy / Q000379:methods*; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D013959:Thyroid Diseases / Q000150:complications; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D002118:Calcium
keywords: Hypercalcaemia; Parathyroid hormone; Parathyroidectomy; Primary hyperparathyroidism; Thyroid disease