Intraoperative Ultrasound Imaging and Sono-Scintigraphic Concordance Improves Success Rates of Minimally Invasive Parathyroidectomy.

Abstract

INTRODUCTION\nThis study aimed to evaluate the effect of sono-scintigraphic correlation on the success of minimal invasive parathyroidectomy (MIP) via surgeon performed continuous intraoperative sonographic guidance in patients operated for primary hyperparathyroidism(PHPT) without intact parathormone (PTH) measurement.\n\n\nMATERIALS AND METHODS\nA retrospective analysis of a prospective database was conducted to review patients who underwent MIP (July 2017-October 2019). The screened parameters were preoperative PTH level, preoperative ultrasonography (US), preoperative scintigraphy, intraoperative US, intraoperative frozen section analysis, postoperative PTH level and permanent pathology report. Intraoperative intact PTH measurement was not employed due to institutional policy.\n\n\nRESULTS\nPreoperative US alone localized the specific side (right/left, inferior/superior) of abnormality in 54 out of 74 (72.97%) cases. Scintigraphy alone localized the specific side in 58 (78.37%) cases. The sensitivity of preoperative US and scintigraphy alone was 76.05% and 86.56%, respectively. Sono-scintigraphic discordance was present in 6 cases (8.1%) and intraoperative real-time US predicted accurate localization of adenoma in 4 (66.6%) and scintigraphy in 2 (44.4%) patients. The frozen section analysis confirmed parathyroid cells in all cases evaluated.\n\n\nCONCLUSION\nSono-scintigraphic concordance with intraoperative real-time imaging increases surgical success rates in cases where MIP is planned under the circumstances of limited resources regarding unavailability of intact PTH measurement.