PREOPERATIVE
LOCALIZATION IN PRIMARY HYPERPARATHYROIDISM – CLINICAL IMPORTANCE OF CONCORTANT
AND NON-CONCORDANT EXAMINATION STUDIES
The two
main preoperative localization studies in patients with primary
hyperparathyroidism (PHPT) are neck ultrasound and Tc99m-sestamibi scan
(functional imaging). When concordant results of sestamibi scan and ultrasound
(performed by experienced investigators) are obtained, a minimally invasive
approach (i.e. focused or targeted parathyroidectomy) can be safely performed,
since in this group of patients the prevalence of multiglandular parathyroid
disease is very small (1 – 3.5 %). In this case, the use of intraoperative
parathormone measurement (IOPTH) is of little value. If, however, results of
preoperative localization with sestamibi scan and ultrasound are not
concordant, minimally invasive parathyroidectomy remains an option, but -in
this case- the use of IOPTH is strongly recommended to verify success of
surgery, since in this subgroup of patients the prevalence of multiglandular
disease is much higher (approaches 17 %). Similarly, IOPTH is recommended for
patients undergoing minimally invasive parathyroidectomy on the basis of a
single preoperative localization study.
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