Use of preoperative ultrasonography adenoma size measurements for accurate localization estimation in parathyroid adenomas

Abstract

Background: It is known that Primary hyperparathyroidism (pHPT) is the most common cause of hypercalcemia. It is characterized by high serum calcium and parathyroid hormone (PTH) levels. Also, hyperactivity is seen in one or more of the parathyroid glands and preoperative ultrasonography (USG) usually localizes the location of parathyroid adenomas. In this study, the factors that affect the success of parathyroid surgery have been investigated. Methods: In total, the medical records of 245 patients with pHPT who underwent parathyroidectomy have been reviewed, retrospectively. In order to confirm the location of hyperactive parathyroid gland and the factors that affect the success of laboratory methods have been examined by using imaging techniques. Results: As a result, false localization is found in 7.8% (19) of the patients. The weight calculated by using the preoperative USG measurements has been approximately similar to the macroscopic weight (p = 0.651). When the preoperative USG results in patients with false localization have been analyzed, it is seen that the lesion diameter was significantly less than 12 mm and the calculated weight was significantly less than 39 g (p = 0.005 and p < 0.001). Conclusion: It has been concluded that a second-line imaging should be used to obtain an accurate localization in patients with a small lesion suspected of being a parathyroid adenoma on preoperative USG. In addition, an intraoperative PTH (IOPTH) should be used to increase the success rate of the surgery in patients who cannot undergo a second-line imaging.