The Effectiveness of Preoperative Ultrasonography and Scintigraphy in the Pathological Gland Localization in Primary Hyperparathyroidism Patients

Özet

Objectives: Primary hyperparathyroidism (pHPT) is a common disease, and its curative treatment is surgical. Nowadays, preoperative localization studies have become standard before surgical treatment, and the first stage imaging methods are ultrasonography and/or scintigraphy. With the contribution of these studies to the localization of the pathological gland, focused surgery hasbecome the first standard of choice. In this study, we aimed to evaluate the efficacy of ultrasonography and scintigraphy in thepreoperative localization of the pathologic gland or glands in patients who underwent surgical treatment and cure for pHPT.Methods: In this study; the data of the biochemically diagnosed pHPT patients, who had Tc 99m-MIBI scintigraphy and/or ultrasonography for localisation preoperatively, were evaluated retrospectively. The lesion, which was positive in USG or scintigraphyfor localization, was evaluated according to the neck side or neck quadrant, and the results were compared with intraoperativelocalization findings. The effectiveness of both methods and combinations was evaluated with the localization rates, sensitivityand positive predictive values (PPV). The three methods were compared with the Youden index (J).Results: The mean age of 380 patients included in this study was 54.8±12.8 years (20-83). Three hundred eight of them werefemale, and 72 were male. Scintigraphy was performed in 339 patients, USG was performed in 344 patients, and both USG andscintigraphy were performed in 306 patients. One hundred twenty patients (32%) underwent bilateral neck exploration (BNE), and260 patients (68.4%) underwent minimally invasive parathyroidectomy (MIP) (unilateral exploration or focused surgery). Singleadenoma was detected in 358 (94%), double adenoma in 10 (3%) and hyperplasia in 12 (3%) patients.Localization rates of USG, scintigraphy, USG and scintigraphy combinations were 53%, 74%, 75%; their sensitivity was 56%, 85%,89%; PPDs were 90%, 86%, 83%. The efficiency of scintigraphy is higher than USG (J: 0.743 vs 0.527). The contribution of scintigraphy to USG in combination with USG was limited (J: 0.743 vs 0.754).The localization rates of USG, scintigraphy, USG and scintigraphy combinations were 46%, 64%, 66%; their sensitivity was 51%,83%, 88%; PPDs were 79%, 74%, 73%. The efficiency of scintigraphy is higher than that of USG (J: 0.64 vs 0.427). The contribution ofscintigraphy to USG in combination with USG was limited (J: 0.64 vs 0.66).Conclusion: In patients with pHPT, scintigraphy is a more effective method for USG as the first step preoperative imaging andshould be preferred as the first method if there is no contraindication. A combination of scintigraphy with USG may contributeminimally to the efficacy of scintigraphy. It may be advantageous for early detection of the pathologic gland in patients with incompatible two imaging and initiating surgery on the positive side of the first scintigraphy. Scintigraphy and USG methods mayallow successful MRP surgery in the majority of patients with pHPT.