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Preoperative localizing studies for initial parathyroidectomy in MEN1 syndrome: is there any benefit?
- Source :
-
World journal of surgery [World J Surg] 2012 Jun; Vol. 36 (6), pp. 1368-74. - Publication Year :
- 2012
-
Abstract
- Background: The objective of the present study was to evaluate the utility of preoperative localizing studies in patients with MEN1 undergoing initial bilateral neck exploration (BNE) and parathyroidectomy for pHPT.<br />Methods: We performed a retrospective analysis of patients diagnosed with MEN1 who underwent initial parathyroidectomy between December 1993 and December 2010. Results of preoperative localizing studies were compared with intraoperative findings and outcome.<br />Results: Sixty patients with MEN1 (32 females and 28 males) underwent initial subtotal parathyroidectomy. The median age at the time of surgery was 33 years (range: 13-78 years). Fifty-three patients had one or more positive localizing study results. Neck ultrasonography, sestamibi scan, parathyroid protocol computed tomography scan, and neck and mediastinum magnetic resonance imaging were performed in 93, 91, 32, and 19% of patients, respectively. Fifty-three patients (88%) had cervical thymectomy. Twenty patients had 24 ectopic parathyroid glands; 18 glands were in the thymus (75%). Preoperative localizing studies identified 9 of 24 ectopic parathyroid glands (38%), including 4 ectopic glands outside the thymus in 4 patients (7%); 3 were detected by ultrasonography. There were no supernumerary glands identified on preoperative localizing studies.<br />Conclusions: In patients with MEN1, preoperative localizing studies identified a subset of ectopic glands (38%). Preoperative localizing studies may alter the operative approach in 7% of patients. Ultrasonography can detect most ectopic parathyroid glands outside thymus. This suggests that routine preoperative localizing studies to identify ectopic and supernumerary enlarged parathyroid glands is not useful in the majority of patients with MEN1 undergoing bilateral neck exploration and subtotal parathyroidectomy with cervical thymectomy.
- Subjects :
- Adolescent
Adult
Aged
Choristoma complications
Choristoma surgery
Female
Humans
Hyperparathyroidism, Primary etiology
Magnetic Resonance Imaging
Male
Middle Aged
Multimodal Imaging
Multiple Endocrine Neoplasia Type 1 complications
Multiple Endocrine Neoplasia Type 1 surgery
Neck diagnostic imaging
Parathyroid Neoplasms complications
Parathyroid Neoplasms surgery
Positron-Emission Tomography
Radiopharmaceuticals
Retrospective Studies
Technetium Tc 99m Sestamibi
Tomography, Emission-Computed, Single-Photon
Tomography, X-Ray Computed
Treatment Outcome
Ultrasonography
Young Adult
Choristoma diagnosis
Hyperparathyroidism, Primary surgery
Multiple Endocrine Neoplasia Type 1 diagnosis
Parathyroid Glands diagnostic imaging
Parathyroid Neoplasms diagnosis
Parathyroidectomy
Preoperative Care methods
Subjects
Details
- Language :
- English
- ISSN :
- 1432-2323
- Volume :
- 36
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- World journal of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 22350475
- Full Text :
- https://doi.org/10.1007/s00268-012-1451-1