Selection of parathyroidectomy methods for primary hyperparathyroidism according to concordance between ultrasonography and MIBI scan results

Abstract

Background: Determination of appropriate operative methods for primary hyperparathyroidism (PHPT) is difficult when localisation results are discordant between imaging studies. The aim of this study was to compare the efficacy of focused parathyroidectomy (FP) and bilateral neck exploration (BNE) according to the concordance in localisation results.

Method: One hundred and ninety-one patients who underwent a PHPT operation at Asan Medical Center between 2000 and 2010 were divided into two groups according to the concordance in findings between neck ultrasonography (USG) and sestamibi (MIBI) scan. Differences in clinicopathological features and surgical outcomes between the concordant (n=137) and discordant (n=54) groups were analysed.

Results: FP and BNE did not show significant differences in postoperative persistent hyperparathyroidism rates. Although intraoperative parathyroid hormone (IOPTH) monitoring was not performed in this study, the cure rates of PHPT using only USG and MIBI scans were satisfactorily high, at 98.5% in the concordant group and 96.3% in the discordant group. The cure rates of FP and Unilateral exploration in single-negative USG and MIBI scans were 100%. Multiple lesions and hyperplasia were more common in the discordant group.

Conclusions: In cases where it is difficult to apply IOPTH, FP without IOPTH is feasible in patients showing concordant or single-negative detection on USG and MIBI scans, whereas BNE is recommended in cases of discordance or double-negative results on imaging studies, to prevent recurrence or persistent disease. Appropriate selection of parathyroidectomy methods according to the concordance in USG and MIBI scans might produce good results without any difference in recurrence.

Keywords: Primary hyperparathyroidism (PHPT); discordant; localization; parathyroidectomy.