Hong Kong Med J 2009;15:118-21 | Number 2, April 2009
Scan-directed unilateral neck exploration for primary hyperparathyroidism: eight-year results from a regional hospital
SW Wong, KW Chan, NM Paulose, HT Leong
Department of Surgery, North District Hospital, Sheung Shui, Hong Kong
OBJECTIVE. To determine the results of scan-directed unilateral neck exploration for primary hyperparathyroidism.
DESIGN. Retrospective study.
SETTING. Regional hospital, Hong Kong.
PATIENTS. Patients who underwent parathyroid surgery for primary hyperparathyroidism between January 2000 and December 2007 were included.
MAIN OUTCOME MEASURES. The demographic, imaging, biochemical, and pathological data, as well as surgical outcomes were analysed according to the treatment received.
RESULTS. A total of 78 patients were included in this study; 65 underwent unilateral neck exploration with image guidance by ultrasonography or technetium Tc99m sestamibi scan. The scan sensitivity for localising the side of the lesion was 66% for ultrasound scans, 71% for technetium Tc99m sestamibi scans, and 85% for both scans used in combination. Pathological analysis showed that 95% (74/78) of the patients had a single parathyroid adenoma, two had hyperplasia of four glands, one had a double adenoma, and one a parathyroid carcinoma. Among the patients undergoing scan-directed unilateral neck exploration, one defaulted follow-up, while the remaining 64 patients achieved normal calcium levels at a median follow-up of 6 months.
CONCLUSION. Scan-directed unilateral neck exploration is a safe alternative form of treatment for patients with primary hyperparathyroidism, with a cure rate similar to conventional therapy.
Key words: Hyperparathyroidism; Parathyroidectomy; Sensitivity and specificity; Technetium Tc99m sestamibi
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