Noninvasive localization procedures in ectopic hyperfunctioning parathyroid tumors

In primary hyperparathyroidism (pHPT), parathyroidectomy is the treatment o f choice, but anatomic variations of ectopic glands may cause surgical fail ure. Reliable preoperative noninvasive localization procedures would have a positive impact on the operative time and increase recovery rate. We retrospectively evaluated 186 patients with pHPT who were studied before successful parathyroidectomy by double tracer scintigraphy (Tc-99m-pertech netate+Tl-201 chloride or Tc-99m-pertechnetate+Tc-99m-sestamibi, 160 patien ts), ultrasonography (148 patients) and computerized tomography (CT) scan ( 92 patients). During bilateral neck exploration, 159 (85.5%) single adenoma s, 6 (3.2%) parathyroid carcinomas, and 3 (1.6%) double adenomas were found . Moreover, 18 (9.7%) patients had diffuse chief cells parathyroid hyperpla sia. Removed parathyroid glands were in ectopic sites in 41 (22.0%) cases, mainly localized in the upper mediastinum or behind the esophagus. The over all sensitivity was 83.5 and 85.2% for Tc-99m-pertechnetate+Tl-201 chloride and Tc-99m-pertechnetate+Tc-99m-sestamibi scintigraphy respectively, 80.4% for CT scan and 81.1% for ultrasonography. In patients with ectopic glands , sensitivity was 81.2, 79.5, 73.3 and 81.6% respectively. In 36 out of 41 patients with ectopic glands in whom the removed parathyroids were correctl y localized, mean operative time was 95 min, and in 5 patients without preo perative localization it was 260 min. In conclusion, in pHPT, preoperative localization of an enlarged parathyroi d is helpful, especially in ectopic adenomas and in anatomic variations in location, and it has been proved to reduce operative time and morbidity rat e.