A. Savage1, R. Wang1, R. Akhund1, S. Balachandra1, A. Gillis1, B. Lindeman1, J. Fazendin1, H. Chen1 1University Of Alabama at Birmingham, Department Of Surgery, Birmingham, Alabama, USA
Introduction: Parathyroidectomy (PTx) is the definitive treatment for primary hyperparathyroidism, with approximately 80% of cases attributed to a single adenoma. Surgeons commonly rely on preoperative imaging to localize parathyroid lesions and facilitate surgical planning. Despite advancements in imaging modalities, the specificity of preoperative imaging localization ranges from 74% to 87%. In cases where imaging yields false negative results, hyperplasia is often presumed to be the underlying pathology. This study aims to assess the incidence and location of single adenomas when one or more preoperative imaging studies yield negative results.
Methods: We performed a single-institution retrospective analysis of patients with primary hyperparathyroidism who underwent parathyroidectomy with preoperative imaging between 2000-2023. We examined three preoperative imaging studies, including ultrasound (US), sestamibi scintigraphy (SS), and computed tomography (CT). Patient demographics, intraoperative findings and surgical pathology were assessed.
Results: We analyzed a total of 3214 patients who underwent PTx, of which, 2047 (64%) received SS scans, 995 (31%) received US scans and 225 (8%) received CT scans. False negative results were observed in 415 (20%) of SS scans, 258 (26%) of US scans and 30 (12%) of CT scans. Subsequent surgical exploration confirmed pathology in these patients, with adenomas identified in 53% of SS cases, 59% of US cases and 56% of CT cases. Thyroid quadrant distribution of these adenomas was analyzed (Table 1). A total of 102 (3%) of patients underwent more than one imaging study. Further analysis of multiple scans revealed that 73 (12%) SES x US scans, 16 (11%) SES x CT scans, 7 (7%) US x CT and 6 (9%) of SES x CT x US yielded false negative results. Subsequent surgical exploration identified single adenomas in 32% of patients who received SES x US scans, 44% of patients who received SES x CT scans, 43% of patients who received US x CT and 50% of patients who received SES x CT x US.
Conclusion: Our results reveal that in false negative preoperative imaging, single adenomas are the most common pathology found on surgical exploration. Thus, parathyroid hyperplasia should not be the presumed underlying pathology when parathyroid imaging studies are negative.
