Original CommunicationFactors Contributing to Negative Parathyroid Localization: An Analysis of 1000 patients
Section snippets
Material and methods
A total of 1,089 consecutive patients underwent PTX between November 1999 to August 2006 for HP at the Cleveland Clinic, Ohio. Excluding patients with prior neck operations, 1,000 consecutive patients with first-time HP who underwent PTX were analyzed and were categorized as follows: SPHP with single gland disease (63%), double adenoma (15%), hyperplasia (15%), secondary/tertiary HP (6%) and familial HP (2%). All subjects in the secondary and tertiary group had chronic renal disease. Neck US
Demographic data
Of the total of 1845 abnormal glands analyzed, 630 involved single adenomas in SPHP, 291 double adenomas in SPHP, 586 hyperplasia in SPHP, 265 hyperplasia in secondary/tertiary HP, and 73 hyperplasia in familial HP. The Table summarizes the demographic data. With respect to etiology, patients with SPHP were older (mean, 60 years) when operated on, while patients with secondary/tertiary HP were the youngest group (mean, 46 years). There were no differences in BMI between subgroups.
Univariate logistic regression analysis, preoperative variables
Greater BMI
Discussion
This is the largest prospective study analyzing the factors affecting the sensitivity of preoperative localization studies for HP. A successful preoperative localization of parathyroid pathology is essential for a focal neck exploration; nevertheless, most of the relevant data are retrospective in nature. In this study, we looked systematically at parameters that might predict an accurate preoperative MIBI scan or US for first-time SPHP in a prospective manner by performing a bilateral neck
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Presented as a poster at the Twenty-Eighth Annual Meeting of the American Association of Endocrine Surgeons, Tucson, Arizona, April 28–May 1, 2007.