American journal of surgery · 2016
Is intraoperative parathyroid hormone monitoring necessary for primary hyperparathyroidism with concordant preoperative imaging?
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Bobanga Iuliana D, McHenry Christopher R
Аннотация
BACKGROUND: The purpose of this study was to determine if intraoperative parathyroid hormone (PTH) monitoring is necessary in patients with concordant ultrasound and sestamibi imaging.
METHODS: Clinical factors, intraoperative findings and outcome were correlated with imaging results in patients with primary hyperparathyroidism who underwent parathyroidectomy with concordant ultrasound and sestamibi imaging.
RESULTS: There were 127 patients with primary hyperparathyroidism and concordant imaging who underwent parathyroidectomy. Seven patients (5.5%) had intraoperative findings that were discordant with imaging: 2 (1.6%) had an adenoma at a different location, 2 (1.6%) had double adenomas and 3 (2.4%) had asymmetric hyperplasia. Gland weight and preoperative PTH levels were greater for patients with concordant operative and imaging findings (p < 0.05).
CONCLUSION: Six percent of patients with concordant ultrasound and sestamibi imaging had unexpected intraoperative findings. Intraoperative PTH monitoring remains a necessary adjunct even with concordant imaging to ensure identification of abnormal parathyroid glands and cure of hyperparathyroidism.
METHODS: Clinical factors, intraoperative findings and outcome were correlated with imaging results in patients with primary hyperparathyroidism who underwent parathyroidectomy with concordant ultrasound and sestamibi imaging.
RESULTS: There were 127 patients with primary hyperparathyroidism and concordant imaging who underwent parathyroidectomy. Seven patients (5.5%) had intraoperative findings that were discordant with imaging: 2 (1.6%) had an adenoma at a different location, 2 (1.6%) had double adenomas and 3 (2.4%) had asymmetric hyperplasia. Gland weight and preoperative PTH levels were greater for patients with concordant operative and imaging findings (p < 0.05).
CONCLUSION: Six percent of patients with concordant ultrasound and sestamibi imaging had unexpected intraoperative findings. Intraoperative PTH monitoring remains a necessary adjunct even with concordant imaging to ensure identification of abnormal parathyroid glands and cure of hyperparathyroidism.