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Endocrine Abstracts (2023) 90 EP163 | DOI: 10.1530/endoabs.90.EP163

1University Basurto Hospital, Endocrinology and Nutrtion, Bilbao, Spain; 2Basque Country University, Bilbao, Spain


Introduction: Minimally invasive surgery has become the standard surgical procedure in Primary Hyperparathyroidism (PHP). Targeted parathyroidectomy is associated with a shorter operative duration, a lower risk of complications and a greater patient satisfaction. This approach is dependent on precise localization of the abnormal gland. 99mTc-sestamibi scintigraphy and ultrasonography are acceptable imaging modalities to detect parathyroid adenoma prior to operation but discrepancies exist with regard to diagnostic accuracy. 18F-fluorocholine positron emission tomography has shown promise results but its availability is only in a few centres. The aim of the present study was to evaluate the efficacy of 99mTc-sestamibi scintigraphy and ultrasonography in surgery for primary hyperparathyroidism.

Subjects and Methods: This is a retrospective observational cohort study in 117 patients diagnosed of PHP who were operated on between January 2017 and January 2022. There were 28 males and 89 females, age range: 35-87 years. All patients underwent ultrasonography and 99mTc-sestamibi scintigraphy before surgery. Surgical procedure was neck exploration (n=42) or selective parathyroidectomy (n=75), according to imaging localization. Statistical analyses used SPSSv20.0 software. Approval of the ethics and research committee was obtained for the study.

Results: Demographic, preoperative, interventional and cure data were compared according to ultrasonography and 99mTc-sestamibi scintigraphy results, distinguishing 3 patient groups: concordant n=68, discordant n=26, negative n=23. Gland weight P=0.03 in ultrasonography, and gland size in 99mTc-sestamibi scintigraphy (P=0.02), but no concomitant thyroid pathology rates, differed significantly between the positive and negative imaging results groups. In the 117 patients, sensitivity was 68% and PPV 81% for ultrasonography, and respectively 74% and 78% for 99mTc-sestamibi scintigraphy. Both modalities were concordant in 68/117 (58%) and in 58 consistent with surgery result (sensitivity 53%). Histopathological analysis showed: 109 adenomas, 1 carcinoma, 5 multiple adenomas. In 2 patients no lesion was shown. In 110 out of 117, calcemia and PTH were normalized one and six months after surgery.

Conclusion: The performance of associated ultrasonography and 99mTc-sestamibi scintigraphy could be the ideal practice to precisely localize parathyroid lesion in patients with PHPT. Combining both techniques can reduce surgical morbidity.

Volume 90

25th European Congress of Endocrinology

Istanbul, Turkey
13 May 2023 - 16 May 2023

European Society of Endocrinology 

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