Success of preoperative imaging and unilateral neck exploration for primary hyperparathyroidism

The surgical treatment of hyperparathyroidism has become controversial with the recent advent of reliable preoperative imaging modalities. This study examines the efficacy and economy of using preoperative imaging studies to localize the pathology and allow for unilateral neck exploration. From January 1990 to May 1996, a total of 91 patients with primary hyperparathyroidism were treated at Swedish Medical Center in Seattle, WA, by 2 surgeons. Eighty-six nuclear scintigraphy studies were performed, of which 44 were technetium 99m sestamibi (Tc-99m-sestamibi) scans and 42 were thalium 99m technetium (Th-99m-Tc) scans, The overall sensitivity for Tc-99m-sestamibi was 91% (40/44), and that for Th-99m-Tc scans was 81% (34/42). Ultrasound examination revealed a sensitivity of 80% (66/82). There was a statistically significant difference in surgical time between the unilateral and bilateral neck explorations (45 minutes, P < 0.0001). Unilateral neck exploration for hyperparathyroidism has been successful in curing hypercalcemia 93% (85/91) of the time with the use of preoperative imaging studies. Tc-99m-sestamibi is a reliable tool for planning the initial unilateral neck exploration for treatment of primary hyperparathyroidism.