Bilateral neck exploration in patients with primary hyperparathyroidism and discordant imaging results: a single-centre study

IntroductionFocused parathyroidectomy is the treatment of choice for patients with concordant positive imaging. Bilateral cervical exploration is performed for cases with discordant imaging, yet more than 70% of those cases are the result of a single-gland disease. As focused parathyroidectomy is ge...

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Bibliographic Details
Published in:European journal of endocrinology 2014-05, Vol.170 (5), p.719-725
Main Authors: Philippon, Melanie, Guerin, Carole, Taieb, David, Vaillant, Josiane, Morange, Isabelle, Brue, Thierry, Conte-Devolx, Bernard, Henry, Jean-Franois, Slotema, Evelyne, Sebag, Frederic, Castinetti, Frederic
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Clinical Competence
Clinical Study
Cohort Studies
Electronic Health Records
Endocrinopathies
Female
Follow-Up Studies
France
Fundamental and applied biological sciences. Psychology
Hospitals, Urban
Humans
Hyperparathyroidism, Primary - diagnostic imaging
Hyperparathyroidism, Primary - pathology
Hyperparathyroidism, Primary - surgery
Male
Medical sciences
Middle Aged
Non tumoral diseases. Target tissue resistance. Benign neoplasms
Parathyroid Glands - diagnostic imaging
Parathyroid Glands - pathology
Parathyroid Glands - surgery
Parathyroidectomy - adverse effects
Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases)
Postoperative Complications - prevention & control
Radionuclide Imaging
Referral and Consultation
Reproducibility of Results
Retrospective Studies
Subtraction Technique
Ultrasonography
Vertebrates: endocrinology
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Summary:IntroductionFocused parathyroidectomy is the treatment of choice for patients with concordant positive imaging. Bilateral cervical exploration is performed for cases with discordant imaging, yet more than 70% of those cases are the result of a single-gland disease. As focused parathyroidectomy is generally costless and harmless, for cases with discordant imaging, we tried to determine whether preoperative characteristics can lead to a diagnosis of single-gland disease.MethodsThis study included 182 patients treated for primary hyperparathyroidism by bilateral exploration from 2009 to 2012 at La Timone Hospital, Marseille, France. We classified patients based on preoperative images and pathological results (single-gland or multiglandular disease). We then compared the demographical, laboratory and imaging results. We also asked a senior nuclear medicine practitioner who was blind to the ultrasound and pathological results to perform a second reading.ResultsOf the total number of patients, 15.4% had negative, 54.4% discordant and 30.2% concordant imaging. After reviewing the scintigraphy results, 8% of the cases with discordant imaging would have been classified as concordant with ultrasound. Subtraction scintigraphy obtained better results than dual-phase scintigraphy (concordance with ultrasound in 50 vs 31% with classical scintigraphy). For the cases of discordant imaging, no predictive factors of single-gland disease could be identified. Ultrasound and scintigraphy were similarly effective in determining the correct location of the abnormal gland.ConclusionDiscordant results of preoperative imaging modalities do not discriminate between uniglandular and multiglandular diseases in hyperparathyroidism. Diagnostic differentiation between the different causes of hyperparathyroidism requires improvements in imaging techniques and might benefit from subtraction scintigraphy.
ISSN:0804-4643
1479-683X
DOI:10.1530/EJE-13-0796