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High Success Rate of Parathyroid Reoperation may be Achieved with Improved Localization Diagnosis

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Abstract

Introduction

Because of the difficulty of reoperative parathyroid surgery, preoperative imaging studies have been increasingly adopted. We report the use of consistently applied localization diagnosis to yield high success rates in parathyroid reoperations.

Methods

Parathyroid reoperation was performed after previous parathyroid surgery in 144 patients with nonmalignant hyperparathyroidism (HPT) between 1962 and 2007. From the year 2000, 46 patients who underwent parathyroid reoperation and 14 patients who were subjected to thyroid surgery before primary parathyroid operation were investigated with sestamibi scintigraphy (MIBI), 11C-methionine PET/CT (met-PET), surgeon-performed ultrasound (US), US-guided fine-needle aspiration biopsy (US-FNA), and selective venous sampling (SVS) with rapid PTH (Q-PTH) analyses. When imaging was considered adequate, additional studies were generally not obtained.

Results

Reversal of hypercalcemia was achieved by reoperation in 134 of 144 (93%) of all patients with previous parathyroid surgery. In patients operated from year 2000, MIBI had 90% sensitivity and 88% predictive value, met-PET 79% sensitivity and 87% predictive value, and US 72% sensitivity and 93% predictive value. SVS with Q-PTH analyses provided accurate localization or regionalization in 11 of 11 recently selected patients. Q-PTH analyses in fine-needle aspirations verified parathyroid origin of excised specimens, and intraoperative Q-PTH helped decide when operations could be terminated. In patients subjected to the algorithm of imaging procedures, reversal of hypercalcemia and apparent cure was obtained after the reoperation in 45 of 46 patients with previous parathyroid surgery, implying a success rate of 98%, and in all patients with previous thyroid surgery.

Conclusions

Reoperative parathyroid surgery is challenging. Results can be improved by consistently applied sensitive methods of preoperative imaging, and reoperative procedures may then achieve nearly the same success rates as primary operations.

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Acknowledgements

The Swedish Cancer Fund and The Swedish Medical Research Council are acknowledged for providing possibilities for this study.

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Authors and Affiliations

  1. Department of Surgery, University Hospital, 751 85, Uppsala, Sweden

    Ola Hessman, Peter Stålberg, Per Hellman & Göran Åkerström

  2. Department of Radiology, University Hospital, 751 85, Uppsala, Sweden

    Anders Sundin & Lars-Gunnar Eriksson

  3. Department of Nuclear Medicine, University Hospital, 751 85, Uppsala, Sweden

    Ulrike Garske

  4. Department of Surgery, Centrallasarettet, 721 89, Västerås, Sweden

    Claes Rudberg

Authors
  1. Ola Hessman
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  2. Peter Stålberg
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  3. Anders Sundin
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  4. Ulrike Garske
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  5. Claes Rudberg
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  6. Lars-Gunnar Eriksson
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  7. Per Hellman
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  8. Göran Åkerström
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Correspondence to Ola Hessman.

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Hessman, O., Stålberg, P., Sundin, A. et al. High Success Rate of Parathyroid Reoperation may be Achieved with Improved Localization Diagnosis. World J Surg 32, 774–781 (2008). https://doi.org/10.1007/s00268-008-9537-5

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  • DOI: https://doi.org/10.1007/s00268-008-9537-5

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