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Directed parathyroidectomy using preoperative and intraoperative localization facilitates unilateral exploration for cure of primary hyperparathyroidism

Donald E Dupuis
Lahey Clinic, Lexington, MA

Objective
To determine the effectiveness of: A) preoperative technetium 99m sestamibi scanning; B) intraoperative PTH assay (iPTH); and C) intraoperative gamma probe (GP) use in conducting unilateral explorations for cure in primary hyperparathyroidism secondary to solitary adenoma.
Table of Contents

  • Design
  • Setting
  • Patients
  • Interventions
  • Main Outcome Measures
  • Results
  • Conclusions

Design Retrospective chart review.
Setting Tertiary care teaching hospital.
Patients 208 consecutive patients who underwent parathyroidectomy for primary hyperparathyroidism from 1/1/00 to 12/31/04.
Interventions Preoperative sestamibi scans, iPTH, and GP localization were utilized in 201, 153, and 90 patients respectively.
Main Outcome Measures Primary outcome measures were: A) successfully directed operations (SDO), unilateral exploration for cure for single adenoma; and B) unsuccessfully directed operations (UDO), bilateral exploration for cure for single adenoma or, unilateral or bilateral explorations with persistent hyperparathyroidism. Statistical analysis: two-tailed Fisher’s exact test.
Results The probability of SDO with a localizing preoperative scan was 75%. With nonlocalizing scans the probabilities of SDO and UDO were 14% and 86% respectively. The benefit of preoperative scanning for achieving SDO was statistically significant (P< 0.001). Gamma probe localization significantly decreased the probability of UDO from 37% to 20% (P=0.015). There was no benefit from iPTH in our study; the probability of SDO with and without iPTH was 70% and 68% respectively (P=0.85).
Conclusions Preoperative sestamibi scanning and intraoperative gamma probe localization effectively increased the probability of successful unilateral explorations for cure in single adenoma primary hyperparathyroidism. Likelihood of successfully directed operation was not significantly improved by iPTH.

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