This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (13)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Otolaryngology/ Head & Neck Surgery  • Endocrine Surgery  • Endoscopy/ Minimally Invasive Surgery  • Ultrasonography  • Endocrine Diseases  • Thyroid/ Parathyroid Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Atul A. Gawande, MD, MPH; Jack M. Monchik, MD; Thomas A. Abbruzzese, MD; Jason D. Iannuccilli, MD; Shahrul I. Ibrahim, MD; Francis D. Moore, Jr, MD

Arch Surg. 2006;141:381-384.

Hypothesis  For patients with primary hyperparathyroidism and patients with 2 localization studies showing the same single location of parathyroid disease, use of intraoperative parathyroid hormone (IOPTH) measurement does not significantly increase the success of minimally invasive parathyroidectomy.

Design  Retrospective cohort study.

Setting  Experience of 2 academic centers over 5 years (at Brigham and Women's Hospital, Boston, Mass) and almost 4 years (at Rhode Island Hospital, Providence).

Patients  A total of 569 patients with primary hyperparathyroidism who underwent technetium Tc 99m sestamibi (MIBI) parathyroid imaging and neck ultrasonography (US).

Main Outcome Measures  Incidence of correct prediction of location and extent of disease.

Results  In 322 patients (57%), MIBI and US imaging identified the same single site of disease. In 319 (99%) of these 322 patients, surgical exploration confirmed a parathyroid adenoma at that site, and the IOPTH levels normalized on removal. In 3 (1%) of the 322 patients, IOPTH measurement identified unsuspected additional disease. In 3 (1%) of the remaining 319 patients, IOPTH-guided removal of a single adenoma failed to correct hypercalcemia. Therefore, the failure rate of surgery in patients with positive MIBI and positive US imaging was 1% with IOPTH measurement and 2% without IOPTH measurement (P = .50). In 201 (35%) of the 569 patients, only 1 of the 2 studies recognized an abnormality or the studies disagreed on location. In these cases, either MIBI imaging or US imaging (if MIBI imaging was negative) failed to predict the correct site or extent of disease in 76 (38%) of the 201 patients (P<.001 vs concordant studies).

Conclusions  In primary hyperparathyroidism, concordant preoperative localization with MIBI and US imaging is highly accurate. Use of IOPTH measurement in these cases adds only marginal benefit. When only 1 of the 2 studies identifies disease or the studies conflict, however, IOPTH measurement remains essential during minimally invasive parathyroidectomy.

Author Affiliations: Harvard School of Public Health (Dr Gawande) and Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (Drs Gawande, Abbruzzese, Ibrahim, and Moore), Boston, Mass; and Department of Surgery, Rhode Island Hospital and Brown Medical School, Providence (Drs Monchik and Iannuccilli).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Minimally Invasive Parathyroidectomy: Use of Intraoperative Parathyroid Hormone Assays After 2 Preoperative Localization Studies
Smith et al.
Arch Otolaryngol Head Neck Surg 2009;135:1108-1111.
ABSTRACT | FULL TEXT  

Surgery for Hyperparathyroidism in Image-Negative Patients
Chan et al.
Arch Surg 2008;143:335-337.
ABSTRACT | FULL TEXT  

Radiology Quiz Case 1: Diagnosis
Arch Otolaryngol Head Neck Surg 2007;133:616-617.
FULL TEXT