Author(s)

Daniel Margain¹, Rodrigo Arrangoiz^1*, Adrian Legaspi¹, Vanitha Vasudevan¹, Amit Sastry¹, Frank De La Cruz¹, Jeronimo Garcialopez De Llano¹, Jennifer Fernandez¹, Loisani Galindo¹, Noah Llaneras¹, Matthew Farrell¹, Gonzalo Fernandez-Christlieb², Fernando Cordera³

¹Center for Advanced Surgical Oncology, Hialeah, FL, USA.
²American British Cowdray Medical Center, Mexico City, Mexico.
³Sociedad Quirurgica S.C. at the American British Cowdray Medical Center, Mexico City, Mexico.

Background: Primary hyperparathyroidism (pHPT) is one of the most common endocrine diseases and the most common cause of hypercalcemia. Since routine laboratory testing, the prevalence of the disease has increased from 0.1% to 0.4% worldwide. The only curative treatment is parathyroidectomy. Nowadays, preoperative localization studies have become standard before surgical treatment, and the first stage imaging methods are cervical ultrasonography (US) and/or Sestamibi scintigraphy. Objectives: To describe the accuracy of US and Sestamibi for detection of hyperfunctioning parathyroid adenomas preoperatively in patients with confirmed pHPT from our medical institution. Results: This is a retrospective study from a prospectively kept database that included thirty-one patients with the confirmed diagnosis of pHPT clinically and biochemically. The average age was 57.8 years old. Preoperative US and surgery findings were compared with a sensitivity of 51%. Preoperative Sestamibi and surgery findings were compared resulting in a sensitivity of 71%. Both imaging methods combined, resulted in a sensitivity of 80%. Conclusion: In patients with pHPT, Sestamibi is an effective method for localizing parathyroid pathology preoperatively, but the false negative rate can be high. US tends to have a wider range explained by the operator-dependent factor. The combination of US and Sestamibi reduces the rate of false negatives, as reported in international literature. It is important to mention that these studies cannot be used as a confirmatory test for this disease. It should only be used as an adjunct to help plan the operation.

Parathyroid Glands, Primary Hyperparathyroidism, Parathyroid Adenoma, Parathyroid Hyperplasia, Parathyroidectomy, Cervical Ultrasound, Sestamibi Scintigraphy, Limited Neck Exploration

Margain, D. , Arrangoiz, R. , Legaspi, A. , Vasudevan, V. , Sastry, A. , De La Cruz, F. , De Llano, J. , Fernandez, J. , Galindo, L. , Llaneras, N. , Farrell, M. , Fernandez-Christlieb, G. and Cordera, F. (2022) The Role of Preoperative Ultrasound and Sestamibi Scintigraphy in the Surgical Management of Primary Hyperparathyroidism: A Review of Literature. International Journal of Otolaryngology and Head & Neck Surgery, 11, 91-105. doi: 10.4236/ijohns.2022.112010.