Background: There has been an increase in prevalence of primary hyperparathyroidism (pHPT) in recent decades, with a corresponding rise in parathyroidectomies. Our aim was to assess the correlation of preoperative imaging with intra-operative findings in pHPT and determine the benefits of preoperative localisation.
Methods: This was a retrospective review of consecutive parathyroid surgeries performed by a single surgeon over 20 months. Patients underwent preoperative ultrasound and sestamibi/single-proton emission computed tomography (SPECT CT) for disease localisation. We assessed the correlation of radiological findings with incision size and operative duration.
Results: Our study included 75 patients (60 female, 15 male). Mean age was 60 years. Sixty-eight patients underwent both ultrasound and sestamibi/SPECT CT. Disease was correctly lateralised in both scans in 25 cases (37%), did not lateralise in 22 (32%), and imaging was discordant in 21 (31%). When both scans were positive, mean duration of surgery was 31 minutes, compared with 75 minutes if scans failed to localise disease (P<0.0001). Positive imaging was also significantly associated with a smaller average incision (2.6 vs. 3.6 cm, P<0.0001). Most patients with pHPT (89%) had a single adenoma.
Conclusions: The accuracy of imaging in localising parathyroid adenomas was lower than internationally reported. We caution reliance on these imaging modalities and suggest surgeons may expect imaging and intra-operative findings in line with our results. Positive imaging is associated with reduced operative time and smaller incision. Adjuncts such as 4D-CT and intra-operative PTH measurement may be useful in cases with negative imaging, however, feasibility in all patients is limited due to availability, cost, and radiation exposure.
