The Relationship of Negative Imaging Result and Surgical Success Rate in Primary Hyperparathyroidism

Objectives: In present, the effect of pre-operative negative imaging results on surgical outcomes of primary hyperparathyroidism (pHPT) is still controversial. In this study, we aimed to evaluate the effect of pre-operative imaging on surgical outcomes.
Methods: The data of pHPT patients who were operated between 2009 and 2018 were evaluated retrospectively. Patients were divided three groups according to scintigraphy and/or ultrasonography results: Group 1; both imaging positive, Group 2; single imaging positive, and Group 3; patients in whom both imaging modalities are negative. Pre-operative biochemical characteristics, parathyroid pathologies, diameter and volume of the pathological gland, surgery rates, persistence, and recurrent disease rates of the groups were compared.
Results: Of 311 patients (258F, 53M) with a mean follow-up period of 24.7±18 months and a mean age of 54.1±12.9 years; 161 were in Group 1, 111 were in Group 2, and 39 were in Group 3. The diameter of pathological gland (2.1±0.8, 1.6±0.9, 1.5±0.7 cm; p<0.001; in Group 1,2,3 respectively) and the volume of pathological gland (2±3.2, 1.4±2.9, 1.1±2.2 cm3; p<0.001; in Group 1,2,3, respectively) in Group 1; the rate of multi gland disease (5.7%, 11%, 21%; p=0.024; in Group 1, 2, 3, respectively) in Group 3 were significantly higher. In the 1, 2, 3 group; bilateral exploration rates were 93.2%, 48.6%, and 5.1%, and focused surgery or unilateral exploration rates were 6.8%, 51.4%, and 94.9%, respectively, with a significant difference (p<0.001). After the first surgery, the cure rate was 91.3%, 93.7%, and 89.7%, and the persistent patient rate was 7.5%, 3.6%, and 10.3% in Groups 1,2,3, respectively, and there was no significant difference. At the end of the follow-up period after secondary intervention applied in persistent and recurrent patients, the overall cure rate was 97.4%, 96.4%, and 97.4%, persistent disease rate 1.3%, 1.8%, and 2.6%, recurrent disease rate 1.3%, 1.8%, and 0%, respectively.
Conclusion: In imaging-negative patients with pHPT, the possibility of multi gland disease and smaller pathological glands should be considered at the time of surgery. Surgery in imaging-negative patients can be performed with a similar and acceptable cure rate to imaging-positive patients.

Primer Hiperparatiroidizmde Negatif Görüntüleme Sonucu ile Cerrahi Baþarý Oraný Ýliþkisi

Giriþ: Günümüzde halen primer hiperparatiroidi (pHPT)’li hastalarda preoperatif negatif görüntülemenin cerrahi sonuçlar üzerine etkisi tartýþmalýdýr. Bu çalýþmada preoperatif görüntülemenin cerrahi sonuçlara etkisini deðerlendirmeyi amaçladýk.
Materyal ve Metod: 2009-2018 tarihleri arasýnda opere edilen pHPT’li hastalarýn verileri retrospektif olarak deðerlendirildi. Hastalar sintigrafik ve/veya ultrason görüntüleme pozitifliðine göre 3 gruba ayrýldý: Grup 1; her iki görüntüleme pozitif, Grup 2; bir görüntüleme pozitif, Grup 3; her iki görüntüleme yönteminin de negatif olduðu hastalar. Gruplarýn preoperatif biyokimyasal özellikleri, paratiroid patolojileri, patolojik bezin çapý ve hacmi, uygulanan ameliyat oranlarý, persistan ve reküren hastalýk oranlarý karþýlaþtýrýldý.
Bulgular: Ortalama takip süresi 24,7+18 olan ve yaþ ortalamasý 54,1+12,9 olan 311 hastanýn (258K, 53E) 161’I grup 1, 111’i grup 2, 39’u grup 3’te yer almaktaydý. Grup 1’de patolojik bez çapý (Grup 1, 2, 3’te sýrasý ile 2.1±0.8, 1.6±0.9, 1.5±0.7 cm; p<0.001), patolojik bez hacmi (Grup 1, 2, 3’te sýrasý ile 2±3.2, 1.4±2.9, 1.1±2.2 cm3; p<0.001), grup 3’te çoklu bez hastalýðý oraný (Grup 1, 2, 3’te sýrasý 5.7%, 11%, 21%; p=0.024) anlamlý olarak daha yüksekti (p=0.024). Grup 1,2,3’te bilateral eksplorasyon oraný sýrasý ile 93.2%, 48.6%, 5.1% olup, odaklanmýþ cerrahi veya unilateral boyun eksplorasyonu oranlarý sýrasý ile 6.8%, 51.4%, 94.9% olup fark anlamlý idi (p<0.001). Ýlk cerrahi sonrasý grup 1,2,3’te sýrasý ile kür oraný 91.3%, 93.7%, 89.7%, persistan hasta oraný 7.5%, 3.6%, 10,3% olup anlamlý fark yoktu. Persistan ve nüks hastalarda uygulanan ikincil giriþim sonrasý takip süresi sonunda toplam kür oraný sýrasý ile 97.4%, 96.4%, 97.4%, persistans hastalýk oraný 1.3%, 1.8%, 2.6%, nüks
hastalýk oraný 1.3%, 1.8%, %0 olarak saptandý.
Sonuç: pHPT’li görüntüleme negatif olgularda cerrahi sýrasýnda çoklu bez hastalýðý olasýlýðý ve daha küçük patolojik bez olasýlýðýnýn yüksek olabileceði göz önüne alýnmalýdýr. Görüntüleme negatif hastalarda cerrahi görüntüleme pozitif hastalar benzer ve kabul edilebilir kür oraný ile uygulanabilir. (SETB-2023-01-019)