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Accuracy of Parathyroid Adenoma Localization by Preoperative Ultrasound and Sestamibi in 1089 Patients with Primary Hyperparathyroidism

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Abstract

Background

Primary hyperparathyroidism (pHPT) is well treatable surgically. Sonography (US) and sestamibi scintigraphy (MIBI) are used routinely, but it is unclear how valuable they are in determining Parathyroid glands’ different locations. This study aimed to evaluate the prognostic value of US and MIBI in relation to the different localization of parathyroid adenomas in one of the largest study populations analyzed to date.

Methods

1089 patients with pHPT who had treatment in one tertiary referral center between 2007 and 2016 were analyzed. Preoperative US and MIBI reports were compared with the parathyroid adenoma's intraoperative localization. All parathyroid glands were confirmed by histological diagnosis.

Results

No gland was detectable in 22.5% and 27.7% of all patients, by US or by MIBI, respectively. In relation to the different adenoma locations, the sensitivity of US ranged from 21.3% (upper right) to 68.9% (lower left) and of MIBI ranged from 23.5% (upper right) to 72% (lower left). The specificity for US ranged from 85% (lower right) to 99.2% (upper right) and for MIBI ranged from 86.1% (lower right) to 99.1% (upper right. Positive predictive values for all gland sites were 54% and 59% for MIBI and US, respectively. The value increased for side-only prediction to 73% and 78%, respectively. Neither the parathyroid hormone level nor the calcium value level influenced the sensitivity or specificity of the two test methods.

Conclusions

The validity of preoperative US and MIBI depends crucially on the specific localization of adenomas. This should be considered when planning the extent of parathyroid surgery.

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Abbreviations

BNE:

Bilateral neck exploration

PTH:

Parathyroid hormone

UE:

Unilateral neck exploration

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Funding

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

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Author notes

  1. Alexandra Zahn and Kirsten Lindner have contributed equally.

Authors and Affiliations

  1. Department of Internal Medicine I, University Hospital Schleswig-Holstein Campus Lübeck and Institute for Endocrinology and Diabetes - Molecular Endocrinology, Center of Brain Behavior and Metabolism CBBM, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany

    K. Alexander Iwen

  2. Department of Endocrine Surgery, Schön Klinik Hamburg-Eilbek, Dehnhaide 120, 22081, Hamburg, Germany

    Jochen Kußmann, Volker Fendrich & Alexandra Zahn

  3. Department of Endocrine Surgery, LAKUMED, Krankenhausstr. 2, 84137, Vilsbiburg, Germany

    Kirsten Lindner

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  1. K. Alexander Iwen
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Contributions

Study concept and design were contributed by KAI, VF, KL, AZ; acquisition of data was contributed by KAI, KL, AZ; analysis and interpretation of data were contributed by KL, KAI; drafting manuscript was contributed by KAI, KL; critical revision of manuscript was contributed by KAI, KL, JK, VF, AZ. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Alexandra Zahn.

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Informed consent was obtained from all individual participants included in the study.

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Iwen, K.A., Kußmann, J., Fendrich, V. et al. Accuracy of Parathyroid Adenoma Localization by Preoperative Ultrasound and Sestamibi in 1089 Patients with Primary Hyperparathyroidism. World J Surg 46, 2197–2205 (2022). https://doi.org/10.1007/s00268-022-06593-y

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  • DOI: https://doi.org/10.1007/s00268-022-06593-y

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