Role of Imaging in the Localization of Parathyroid Adenoma

Aims/Objectives Recently minimally invasive parathyroidectomy has been developed. For this reason, preoperative localization is playing an important role to detect the precise location of the affected gland and to increase success rate. It has been mentioned in the literature that if preoperative localization of parathyroid gland is considered necessary the investigations of choice are 99Tc Sestamibi scanning, and High-resolution ultrasonography. Therefore, the aim of this study is to evaluate the choice of investigation in localizing parathyroid adenoma. Methods Retrospective Study, Imaging, Frozen section & qPTH reports of patients [n= 37] with diagnosis of primary hyperparathyroidism who had undergone parathyroidectomy were reviewed, at King Mills Hospital between May 2010 and Dec.2011. Results 37 patients underwent combined USS & Sestamibi scan, Parathyroid adenoma was localized via USS 25/37 (67.56%), as against 34/37 (91.89%) by Sestamibi-scan and by combined i.e. USS & Sestamibi-Scan 36/37 (97.29%). Histology reported adenomas 32/37 (86.48%), hyperplasia 2/37 (5.40%), carcinoma 1/37 (2.7%), normal histology 2/37 (5.40%) (Uss & mibi scan Negative). In addition to the above, intra operative qPTH showed high levels in 35/37 cases out of which 2 continue to have high levels even after repeating the qPTH levels; both patients had normal histology post operatively; out of which 1 was re-operated (adenoma) the other refused surgery. Conclusions Combined USS and Sestamibi-scan was found to localize parathyroid adenomas with high degrees of accuracy in our hospital (97%). There is also an advantage of doing quick PTH levels compared to frozen section.