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04-05-2006 | Thyroid | Article

Concordant imaging increases parathyroid adenoma localization


Free abstract

Surgeons have found that for patients with primary hyperparathyroidism, imaging with both technetium Tc99m sestamibi (MIBI) and neck ultrasonography is highly accurate in localizing parathyroid adenoma.

Furthermore, the study findings revealed that the use of intraoperative parathyroid hormone (IOPTH) measurement in these patients adds only marginal benefit to minimally invasive parathyroidectomy.

Reporting in the Archives of Surgery, the authors say that the use of MIBI and ultrasonography have allowed surgeons to direct their surgical exploration to the most likely location of a parathyroid adenoma, and IOPTH measurement has enabled them to confirm that removal is curative.

"Precisely which combination of preoperative and intraoperative technologies is most effective, however, remains unclear," they emphasize.

Atul Gawande, from Brigham and Women's Medical Hospital in Boston, Massachusetts, USA, and co-investigators therefore recorded their institutional experience with the two techniques in 569 patients who had primary hyperparathyroidism over a 2-year period.

The same single site of disease was identified in 322 (57%) patients using both techniques. In 319 (99%) of these patients, surgical exploration confirmed the presence of a parathyroid adenoma at this location, and IOPTH levels normalized when the adenoma was removed.

In the remaining three (1%) participants, IOPTH measurements identified additional disease that was unsuspected.

Analyses indicated that the failure rate of surgery in patients with positive MIBI and positive ultrasonography imaging was 1% with IOPTH measurement and 2% without IOPTH measurement.

Therefore the use of IOPTH "provides only marginal, if any, benefit in patients with concordant studies," Gawande and colleagues say.

"When only one of the two studies identifies disease or the studies conflict, however, IOPTH measurement remains essential during minimally invasive parathyroidectomy," they caution.