INITIAL CERVICAL EXPLORATION FOR PARATHYROIDECTOMY IS NOT BENEFITED BY PREOPERATIVE LOCALIZATION STUDIES

Published data is controversial as to the ability of preoperative loca lization studies (PLS) to enhance the outcome of initial cervical expl oration in patients with primary hyperparathyroidism (PHPT). One surge on's experience was reviewed to compare surgical success, operative ti me, and morbidity of initial cervical exploration for PHPT in patients who had undergone PLS versus those who had not. From August 1991 to S eptember 1997, 95 patients who had not undergone prior central cervica l exploration presented for surgical management of PHPT. Sixty-seven p atients underwent initial cervical exploration without any PLS having been performed (Group A). Twenty-eight patients underwent PLS, either alone or in combination, before surgical intervention (Group B). Analy sis of intergroup variability was conducted upon the data available us ing a two-tailed t test for independent samples. In addition, the sens itivities and positive predictive values of the PLS were calculated us ing study reports and operative and histologic findings. There was no statistically significant difference in surgical success between those patients who had PLS and those that did not undergo PLS. Sixty-four o f 67 patients (95.5%) not having PLS were cured with initial surgery, while 27 of 28 patients (96.4%) who had PLS were surgically cured. Mea n postoperative calcium and intact parathormone levels were similar be tween the two groups, and the mean operative time did not differ. Perm anent hypocalcemia occurred in one patient, and five patients had tran sient hoarseness. Thirty-six total PLS were obtained at an average cos t of $752.68/patient, and seven patients underwent multiple tests. Ove rall, sestamibi scan had the highest positive predictive value (81%). For adenomatous disease alone, sestamibi scan was the most sensitive ( 83%). Our study shows that for matched groups limited to age, sex, and clinical diagnosis, the use of PLS did not shorten operative time, de crease complication frequency, nor alter the success of the operation as measured by postoperative calcium and parathormone levels. Therefor e, routine use of preoperative localization studies before initial cer vical exploration for PHPT cannot be recommended.