Endocrine Abstracts

Background: Many Endocrinologists believe that preoperative localisation/lateralization in patients undergoing initial neck exploration for primary hyperparathyroidism is unimportant because of high cure rate in the hands of experienced surgeons. Tcm-MIBI imaging has a sensitivity of 70 to 95% in localizing parathyroid tumors. Ultrasonography has lower sensitivity but is noninvasive and relatively cheap. Unilateral surgical exploration has potential benefits including reduced operative time and reduced operative morbidity such as recurrent laryngeal nerve injuries and hypoparathyroidism.

Aim: To assess the accuracy of preoperative imaging studies in primary hyperparathyroidism.

Methods: Retrospective casenotes review of all patients treated surgically for primary hyperparathyroidism at North Manchester General Hospital between January 2003 and December 2004. 17 patients who had Neck Ultrasonography and SestaMIBI scans as preoperative imaging were included. Results of preoperative imaging studies were compared with surgical and histopathological findings.

Results: 14 of 17(82.35%) patients were female. 12 of 17(70.58%) were over 55 years of age. Ultrasonography correctly localized 8 of 17(47.06%–95% CI 22.98, 72.19). SestaMIBI scan correctly localized 14 of 17(82.35%–95% CI 56.57, 96.2). Histology confirmed parathyroid adenoma in 12 of 14 correctly localized by SestaMIBI and the remaining 2 were inconclusive. In 3 patients incorrectly localized by SestaMIBI, one had a moderate sized multinodular goiter, one had inconclusive histology and only one was true negative. 16 of 17 patient’s calcium normalized after surgery. In only one patient surgery was ineffective and was also complicated by recurrent laryngeal nerve palsy.

Conclusion: Accurate localization of parathyroid tumors is facilitated by imaging, particularly by SestaMIBI scanning. Localisation/lateralization facilitates unilateral surgical exploration which reduces operative time by 30 minutes and also reduces complications. Localisation/ lateralisation is of vital importance in our aging population who often have multiple co-morbidities and are often unfit for surgery under general anaesthesia.