B. A. Jones1, B. Lindeman1, H. Chen1 1University Of Alabama at Birmingham,Department Of Surgery,Birmingham, Alabama, USA
Introduction: Parathyroidectomy for patients with secondary hyperparathyroidism (2HPT) generally required a 4-gland exploration. Some groups have strongly recommended routine pre-operative Tc-99m-sestamibi scans to guide intraoperative planning and to potentially identify ectopic parathyroid glands. Others, including our team, practice scanning for only selected patients. In order to determine the utility of sestamibi scans in this patient population, we reviewed our experience.
Methods: We performed a retrospective review of patients who underwent parathyroidectomy for 2HPT by one surgeon between 2000 and 2018. Data reviewed included patient demographics, laboratory results, pathology and radiology reports, and clinical and operative notes.
Results: Of the 72 patients in the cohort, mean age was 47.2 ± 15.6 and 50% were female. The pre-operative mean calcium and parathyroid hormone levels were 9.6 ± 1.1 mg/dl and 1192.1 ± 914.1 pg/ml, respectively. Sestamibi scans were performed in 21 patients (29%). Of these, 17 were re-operative cases. In the sestamibi cohort, only 4 patients had ectopic glands identified on the scan (2 retroesophageal, 1 thymic, 1 undescended). Among the 61 patients without pre-operative imaging, 16 had ectopic glands (12 thymic, 2 intrathyroidal, 1 carotid sheath, 1 undescended) (26.2% of non-imaged patients, 27.8% of all 2HPT patients). All of these 16 ectopic glands were found by the surgeon at the time of operation without the need for pre-operative imaging. All patients in the series were cured with a minimum follow-up of 6 mos.
Conclusion: Ectopic parathyroid glands are commonly seen in patients undergoing parathyroidectomy for 2HPT. The majority of ectopic glands were successfully identified during the operation without preoperative sestamibi scan. Therefore, routine pre-operative Tc-99m-sestamibi scans are not needed for successful parathyroidectomy for 2HPT.