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Pre-operative localization and surgical outcomes for primary hyperparathyroidism (PHPT): An 11-year review at a South African hospital

Introduction:
Primary Hyperparathyroidism (PHPT) is characterized by hypersecretion of PTH leading to hypercalcaemia with successful surgery being the only definitive cure. Broadly, three techniques of parathyroidectomy exist: open bilateral neck exploration and minimally invasive parathyroidectomy, which is subdivided into open focused approaches and endoscopic focused approaches. A focused parathyroid gland exploration guided by pre-operative imaging is associated with less morbidity compared to a bilateral approach. Focused explorations may target either the side or the specific parathyroid gland identified.
Aim:
The primary aim of this study was to evaluate the accuracy of pre-operative localisation for PHPT in a single centre. The secondary aim was to review the type of parathyroid surgery performed and the final Parathyroid Hormone (PTH) levels in patients who have undergone parathyroidectomy for PHPT.
Methods:
This is a retrospective review of all patients who underwent primary surgery for PHPT between 2005 and 2015. Patients were identified from a general operative database. Data was collected from pathology records, operative notes, nuclear medicine and radiology reports and captured on a confidential data sheet.
Results:
Records of 98 patients were found and included. Sestamibi had a sensitivity of 88%, a positive predictive value of 83% and an accuracy of 75%. Ultrasound had a sensitivity of 52%, a positive predictive value of 78% and an accuracy of 44%. The total number of cases in which both ultrasound and sestamibi were done was 73. Sestamibi and ultrasound showed concordant results in 25 cases. The overall surgical success rate was 94% (92/98). The cure rate for patients in whom sestamibi and ultrasound were concordant, was 96% (24/25). The minimum and maximum calcium levels in the cohort were 2.2 and 4.41 respectively, with a mean of 2.86. PTH levels ranged between 4.2 and 186 with a mean of 33.8. One double adenoma was proven on histology. The rest were all single adenomas. The total number of malignancies were 3 of which 1 was part of a MEN syndrome.
Conclusion:
Our surgical success rate was 94%. When imaging modalities were concordant, surgical success was achieved in 24 cases, thus in 96% of the subgroup. Our figures compare favourably with international standards. There is scope for improvement in the accuracy of both ultrasound (46%) and sestamibi (75%) localization. Currently a combination of both imaging modalities is still recommended.

Identiferoai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/29225
Date04 February 2019
CreatorsVan Wyngaard, Tirsa
ContributorsCairncross, Lydia
PublisherUniversity of Cape Town, Faculty of Health Sciences, Division of General Surgery
Source SetsSouth African National ETD Portal
LanguageEnglish
Detected LanguageEnglish
TypeThesis / Dissertation, Masters, MMed
Formatapplication/pdf

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