Scan-directed mini-incision focused parathyroidectomy: how accurate is accurate enough?

I M Shapey, S Jabbar, Z Khan, J E Nicholson, R J Watson

Research output: Contribution to journalArticlepeer-review

Abstract

INTRODUCTION Mini-incision focused parathyroidectomy (MI-FP) is advocated as an alternative to bilateral neck exploration (BNE), owing to its reduced morbidity. The site and side of the affected gland is identified preoperatively using a combination of ultrasound and sestamibi scans. However, the acceptable degree of inter-scan concordance required to prompt MI-FP without compromising accuracy is undetermined. METHODS Accuracy of preoperative imaging was determined both individually and in combination for all parathyroidectomies (2007-2014). A grading system (excellent, good, poor) was devised to describe the interscan concordance, which was validated by the operative and histological findings. RESULTS Eighty-nine patients (17 male, 68 female) underwent parathyroidectomy (MI-FP 44, BNE 45). The accuracy of scans interpreted individually was 53% for ultrasound and 60% for sestamibi, with no difference according to surgical technique (P = 0.43, P = 1, respectively). The proportion of interscan concordance was: excellent - 35%, good - 40%, poor 25%. Combined accuracy was 100% for both excellent and good grades but only 13% for those graded poor. Similar rates of normocalcaemia were observed for MI-FP and BNE, while postoperative hypocalcaemia was five times higher in those undergoing BNE. CONCLUSIONS Reduction in the inter-scan concordance from excellent to good does not compromise accuracy. MI-FP could be successfully performed in up to 75% of patients - 25% higher than recommended in national guidelines. Focused parathyroidectomy does not compromise surgical and endocrinological outcomes but boasts a far superior complication rate.

Original languageEnglish
Pages (from-to)123-128
Number of pages6
JournalAnnals of the Royal College of Surgeons of England
Volume99
Issue number2
Early online date1 Feb 2017
DOIs
Publication statusPublished - Feb 2017

Keywords

  • Female
  • Humans
  • Male
  • Minimally Invasive Surgical Procedures/adverse effects
  • Parathyroid Diseases/surgery
  • Parathyroid Glands/surgery
  • Parathyroidectomy/adverse effects
  • Postoperative Complications
  • Retrospective Studies
  • Treatment Outcome

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