US researchers have found that a high proportion of patients with sporadic primary hyperparathyroidism (PHPT) who have equivocal pre-operative imaging results can be cured with unilateral surgical exploration alone.
Reporting in the Archives of Surgery, the investigators explain that numerous developments have allowed surgeons to manage individuals with PHPT with minimally invasive unilateral neck surgical exploration rather than bilateral surgical exploration.
These include parathyroid imaging with dual-phase technetium 99m sestamibi (MIBI) parathyroid scintigraphy and the quick intra-operative parathyroid hormone (iPTH) assay.
Therefore, the accurate pre-operative localization of parathyroid adenoma using the MIBI scan is crucial for adequate treatment of patients with PTH, an issue which especially comes into focus when results of this scan are equivocal.
To address this issue, Richard Goldstein, from the University of Louisville in Kentucky, and colleagues prospectively evaluated whether patients with equivocal MIBI scan results are eligible for a unilateral procedure and if so, what the likelihood of this procedure being successful is.
They found that, out of 464 patients that attended hospital with PTH, 72 had equivocal scan results.
Of these 72 patients, 39 underwent unilateral surgical exploration and 33 received bilateral surgical explorations.
Ninety-seven percent of the patients that underwent unilateral explorations were cured. The procedure failed in one patient and this was attributed to a false-positive iPTH level decrease.
"The data from the current study suggest that these patients with PHPT can be successfully managed, in many cases with a unilateral surgical procedure, using an algorithm that incorporates minimally invasive radioguided parathyroidectomy with the iPTH assay," Goldstein et al conclude.