Evaluation of diagnostic and localization of offending glands in hyperparathyroid patients in two educational hospitals of Tehran University of medical sciences during 10 years (1989-1998)

Introduction: Diagnosis and localization of offending glands in hyperparathyroid patients is a subject that has always concerned surgeons. Until two decades ago this could only be achieved through complete neck exploration by the surgeon. In recent decades, with introduction of better imaging techniques such as advanced sonography and isotopic scans, remarkable progress has been made in this field. To evaluate these techniques a study was designed and performed. Materials and Methods: This is a retrospective descriptive study in a group of patients with primary hyperparathyroidism who underwent parathyroidectomy in Imam Khomeini General hospital and Dr. Shariati General hospital, Tehran university of medical sciences, during the years 1989 to 1998. The purpose of this study is to evaluate the sensitivity and accuracy of the available imaging facilities in diagnosis and localization of the offending gland(s), compared to intraoperative findings. Findings: 61 patients were studied. 11 men (18%) and 50 women (82%) 47 single adenoma (77%), 2 multiple adenoma (3%) and 12 hyperplasias (20%) were reported. 24 patients with single adenoma had MIbI scan with a sensitivity and accuracy of 70% and 100%, respectively. In all cases of multiple adenoma and hyperplasia who had MIbI scan, the results was false negative. Sensitivity of Th-Tc scan for single sadenoma was 33.3%. Sonography had a sensitivity of 71.5% for adenoma and 40% for hyperplasa with 100% accuracy for both of them. Sensitivity and accuracy of intraoperative diagnosis and localization for adenoma was 100% and 96.7%, respectively. For hyperplasia these figures were 83.3% sensitivity and 100% accuracy. Conclusion: According to the results in diagnosis and localization of offending gland(s) in primary hyperparathyroidism, intraoperative judgment of experienced surgeon has a higher sensitivity and accuracy than available imaging facilities. This is specially true for multiple adenoma and hyperplasia. Therefore, we suggest that still during surgery for hyperparathyroidism all parathyroid glands should be explored, and limited dissection directed by imaging findings should be avoided. However, with increasing experience and introduction of new technologies such as radiotracing, one may expect better results from imaging day by day.