PRIMARY HYPERPARATHYROIDISM-
WHAT’S THE ROLE OF PREOPERATIVE IMAGING?
Diagnosis
of primary hyperparathyroidism (PHPT) is established based upon biochemical
findings. Imaging should not be used as a diagnostic tool, given the very high
false positive rates (ranging from 5 % up to 25 %). Preoperative localization
studies (PLSs) are used to identify the hyperfunctioning parathyroid parenchyma
(most often [85 %] solitary parathyroid adenoma, sometimes in ectopic
locations). In clinical practice, neck ultrasonography and Tc99m-sestamibi parathyroid
scanning are the two most commonly used PLSs. Other useful PLSs include
sestamibi with single-photon emission computed tomography (SPECT) and
four-dimensional computed tomography (4D-CT) (used in more complicated cases,
such as in recurrent/persistent PHPT).
PLSs are
currently used to help plan the surgical approach in patients with
biochemically confirmed diagnosis of PHPT, and guide the surgeon during the
minimally invasive approach (minimally invasive parathyroidectomy, MIP).
While preoperative
localization studies are useful for the surgeon performing initial parathyroid
surgery, these studies are MANDATORY in patients undergoing reoperative surgery
for recurrent / permanent PHPT. The success rate of reoperative surgery without
preoperative localization is very low (~ 60 %). In contrast, success rate is
> 95 % with the use of preoperative localization before reoperation.
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