The changing face of reoperative parathyroidectomy: a single-centre comparison of 147 parathyroid reoperations

• Published in: Annals of the Royal College of Surgeons of England Vol. 103; no. 1; pp. 29 - 34
• Main Authors: Camenzuli, C, DiMarco, AN, Isaacs, KE, Grant, Y, Jackson, J, Alsafi, A, Harvey, C, Barwick, TD, Tolley, N, Palazzo, FF
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.01.2021; Royal College of Surgeons
• Subjects: Adolescent; Adult; Age; Aged; Aged, 80 and over; Biopsy, Fine-Needle - statistics & numerical data; Demographics; Endocrine Surgery; Endocrine system; Female; Four-Dimensional Computed Tomography - statistics & numerical data; Humans; Hyperparathyroidism, Primary - blood; Hyperparathyroidism, Primary - diagnosis; Hyperparathyroidism, Primary - pathology; Hyperparathyroidism, Primary - surgery; Localization; Male; Medical imaging; Middle Aged; Parathyroid Glands - diagnostic imaging; Parathyroid Glands - metabolism; Parathyroid Glands - pathology; Parathyroid Glands - surgery; Parathyroid Hormone - analysis; Parathyroid Hormone - metabolism; Parathyroidectomy - statistics & numerical data; Patients; Positron Emission Tomography Computed Tomography - methods; Positron Emission Tomography Computed Tomography - statistics & numerical data; Radionuclide Imaging; Recurrence; Reoperation - statistics & numerical data; Retrospective Studies; Secondary Prevention - methods; Secondary Prevention - statistics & numerical data; Surgeons; Surgery; Surgical outcomes; Technetium Tc 99m Sestamibi - administration & dosage; Thyroid gland; Treatment Outcome; Ultrasonic imaging; Ultrasonography - statistics & numerical data; Young Adult; Parathyroid glands; Primary hyperparathyroidism; Parathyroidectomy; Parathyroid diseases
• ISSN: 0035-8843; 1478-7083; 1478-7083
• DOI: 10.1308/rcsann.2020.0185

Reoperative parathyroidectomy for persistent and recurrent primary hyperparathyroidism is dependent on radiology. This study aimed to compare outcomes in reoperative parathyroidectomy at a single centre using a combination of traditional and newer imaging studies. Retrospective case note review of all reoperative parathyroidectomies for persistent and recurrent primary hyperparathyroidism over five years (June 2014 to June 2019; group A). Imaging modalities used and their positive predictive value, complications and cure rates were compared with a published dataset spanning the preceding nine years (group B). From over 2000 parathyroidectomies, 147 were reoperations (101 in group A and 46 in group B). Age and sex ratios were similar (56 vs 62 years; 77% vs 72% female). Ultrasound use remains high and shows better positive predictive value (76% vs 57 %). 99mTc-sestamibi use has declined (79% vs 91%) but the positive predictive value has improved (74% vs 53%). 4DCT use has almost doubled (61% vs 37%) with better positive predictive value (88% vs 75%). 18F-fluorocholine positron emission tomography-computed tomography and ultrasound-guided fine-needle aspiration for parathyroid hormone are novel modalities only available for group A. Both carried a positive predictive value of 100%. Venous sampling with or without angiography use has decreased (35% vs 39%) but maintains a high positive predictive value (86% vs 91%). Cure rates were similar (96% vs 100%). Group A had 5% permanent hypoparathyroidism, 1% permanent vocal cord palsy and 1% haematoma requiring reoperation. No complications for group B. Optimal imaging is key to good cure rates in reoperative parathyroidectomy. High-quality, non-interventional imaging techniques have produced a shift in the preoperative algorithm without compromising outcomes.