Correlation of preoperative localisation of parathyroid adenoma with imaging findings and surgical outcome

Abstract

Objective: To assess the outcomes of parathyroidectomy in primary hyperparathyroidism with or without preoperative imaging localisation, and to evaluate the association with surgical cure.

Method: The retrospective cohort study was conducted from August 2022 to January 2023 at the Aga Khan University Hospital, Karachi, and comprised records of all adult primary hyperparathyroidism patients who underwent parathyroidectomy between January 2011 and December 2021. Demographic, surgical and outcome data was recorded. Imaging data included sestamibi scan and ultrasound. Cure was defined as normalisation of calcium and parathyroid hormone levels postoperatively and at two-week follow-up. Data was analysed using SPSS 19.

Results: Of the 140 patients with mean age 48.23±15.1 years, 100(71.4%) were female. Most patients had a single adenoma 129(92.1%). Unilateral neck exploration was performed in 95.7% patients. Cure rates were highest in dual localised cases involving bot ultrasound and sestamibi scan 90.3% compared to 70.7% for those with only sestamibi scan, and 89.7% for ultrasound-only localisation.

Conclusion: Preoperative ultrasound positivity was associated with high cure rate after parathyroidectomy for primary hyperparathyroidism. Dual positive imaging with both ultrasound and sestamibi scans demonstrated a numerically high cure rate, supporting the use of ultrasound as the first localisation modality and sestamibi scan as an adjunct when ultrasound is inconclusive.

Key Words: Adenoma, Hypercalcemia, Parathyroid carcinoma, Primary hyperparathyroidism.