Optimizing surgical outcomes through preoperative parathyroid localization

Authors

  • Banyeswar Pal Department of General Surgery, All India Institute of Medical Sciences, Basantapur, Kalyani, West Bengal, India
  • Hem Narayan Jha Department of General Surgery, Burdwan Medical College & Hospital, Purba Burdhaman, West Bengal, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20250694

Keywords:

Preoperative localization, Parathyroid surgery, Ultrasonography, Surgical outcomes

Abstract

Preoperative parathyroid localization is pivotal in ensuring surgical precision and optimizing outcomes in patients with parathyroid disorders. Advances in imaging techniques have significantly enhanced diagnostic accuracy and reduced complications. A systematic search strategy was designed to identify relevant literature published between June 2014 and September 2024. Databases including PubMed, Scopus, and Google Scholar were utilized, using search terms such as "preoperative localization," "parathyroid imaging," "parathyroidectomy outcomes," "ultrasonography," "SPECT," and "4D-CT." Inclusion criteria encompassed studies focusing on preoperative imaging modalities for parathyroid localization, those evaluating surgical outcomes, and original research articles in English. The qualitative synthesis emphasized patterns in imaging efficacy and surgical outcomes across different studies. Among the imaging techniques, 4D-CT demonstrated the highest localization accuracy (95%), followed by SPECT (89%) and ultrasonography (80%). Patients with precise preoperative localization experienced shorter operative times, fewer complications, and higher rates of surgical success compared to those without effective localization. Integrating advanced imaging modalities into preoperative planning significantly improves surgical precision and outcomes in parathyroid surgery. These findings advocate for their routine use in clinical practice to enhance patient care.

Metrics

Metrics Loading ...

References

Stack BC Jr, Tolley NS, Bartel TB, Bilezikian JP. AHNS Series: Do you know your guidelines? Optimizing outcomes in preoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons. Head Neck. 2018;40(8):1617-29. DOI: https://doi.org/10.1002/hed.25023

Balachandra S, Chen H. Strategies for reoperative parathyroidectomy. Surgical Oncol Insight. 2024;1(3):100078. DOI: https://doi.org/10.1016/j.soi.2024.100078

Tay D, Das JP, Yeh R. Preoperative Localization for Primary Hyperparathyroidism: A Clinical Review. Biomedicines. 2021;9(4):390. DOI: https://doi.org/10.3390/biomedicines9040390

Tay YKD, Yeh R, Kuo JH, McManus C, James AL, John PB. Pre-operative localization of abnormal parathyroid tissue by 99mTc-sestamibi in primary hyperparathyroidism using four-quadrant site analysis: An evaluation of the predictive value of vitamin D deficiency. Endocrine. 2018;60(1):36-45. DOI: https://doi.org/10.1007/s12020-018-1528-1

Yeh R, Tay YK, Dercle L, Bandeira L, Parekh MR, Bilezikian JP. A Simple Formula to Estimate Parathyroid Weight on 4D-CT, Predict Pathologic Weight, and Diagnose Parathyroid Adenoma in Patients with Primary Hyperparathyroidism. Am J Neuroradiol. 2020;41(9):1690-7. DOI: https://doi.org/10.3174/ajnr.A6687

Wilhelm SM, Wang TS, Ruan DT, James AL, Sylvia LA, Quan-Yang D, et al. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyper-parathyroidism. JAMA Surg. 2016;151(10):959-68. DOI: https://doi.org/10.1001/jamasurg.2016.2310

Zafereo M, Yu J, Angelos P, Brumund K, Kevin B, Hubert HC, David G, et al. American Head and Neck Society Endocrine Surgery Section update on parathyroid imaging for surgical candidates with primary hyperparathyroidism. Head Neck. 2019;41(7):2398-409. DOI: https://doi.org/10.1002/hed.25781

Kuzminski SJ, Sosa JA, Hoang JK. Update in Parathyroid Imaging. Magn Reson Imaging Clin N Am. 2018;26(1):151-66. DOI: https://doi.org/10.1016/j.mric.2017.08.009

Yeh R, Tay YKD, Tabacco G, Laurent D, Jennifer HK, Leonardo B, et al. Diagnostic Performance of 4D CT and Sestamibi SPECT/CT in Localizing Parathyroid Adenomas in Primary Hyperparathyroidism. Radiology. 2019;291(2):469-76. DOI: https://doi.org/10.1148/radiol.2019182122

Krakauer M, Wieslander B, Myschetzky PS, Anke L, Theis B, Christian HS, et al. A Prospective Comparative Study of Parathyroid Dual-Phase Scintigraphy, Dual-Isotope Subtraction Scintigraphy, 4D-CT, and Ultrasonography in Primary Hyperparathyroidism. Clin Nucl Med. 2016;41(2):93-100. DOI: https://doi.org/10.1097/RLU.0000000000000988

Kluijfhout WP, Pasternak JD, Drake FT, Toni B, Jessica EG, Wen TS, et al. Use of PET tracers for parathyroid localization: A systematic review and meta-analysis. Langenbeck’s Arch Surg. 2016;401:925-35. DOI: https://doi.org/10.1007/s00423-016-1425-0

Parvinian A, Martin-Macintosh EL, Goenka AH, Jolanta MD, Brian PM, Brad JK, et al. 111C-Choline PET/CT for Detection and Localization of Parathyroid Adenomas. Am J Roentgenol. 2018;210(2):418-22. DOI: https://doi.org/10.2214/AJR.17.18312

Thanseer N, Bhadada SK, Sood A, Bhagwant RM, Arunanshu B, Arun KRG, et al. Comparative Effectiveness of Ultrasonography, 99mTc-Sestamibi, and 18F-Fluorocholine PET/CT in Detecting Parathyroid Adenomas in Patients with Primary Hyperparathyroidism. Clin Nucl Med. 2017;42(12):e491-7. DOI: https://doi.org/10.1097/RLU.0000000000001845

Patel SG, Saunders ND, Jamshed S, Weber CJ, Sharma J. Multimodal preoperative localization improves outcomes in reoperative parathyroidectomy: a 25-year surgical experience. Am Surgeon. 2019;85(9):939-43. DOI: https://doi.org/10.1177/000313481908500932

Fazendin JM, Lindeman B, Chen H. Preoperative parathyroid localization does not improve surgical outcomes for patients with primary hyperparathyroidism. Am J Surg. 2020;220(3):533-5. DOI: https://doi.org/10.1016/j.amjsurg.2020.04.029

Parikh AM, Suliburk JW, Morón FE. Imaging localization and surgical approach in the management of ectopic parathyroid adenomas. Endocrine Pract. 2018;24(6):589-98. DOI: https://doi.org/10.4158/EP-2018-0003

Memeh KO, Palacios JE, Khan R, Guerrero MA. Pre-operative localization of parathyroid adenoma: performance of 4D MRI parathyroid protocol. Endocrine Practice. 2019;25(4):361-5. DOI: https://doi.org/10.4158/EP-2018-0424

Noureldine SI, Gooi Z, Tufano RP. Minimally invasive parathyroid surgery. Gland Surg. 2015;4(5):410.

Guerin C, Lowery A, Gabriel S, Castinetti F. Preoperative imaging for focused parathyroidectomy: making a good strategy even better. Eur J Endocrinol. 2015;172(5):519-26. DOI: https://doi.org/10.1530/EJE-14-0964

Ramonell KM, Chen H, Lindeman B, Fazendin J. Re-operative parathyroidectomy: How many positive localization studies are required? Am J Surg. 2021;221(2):485-8. DOI: https://doi.org/10.1016/j.amjsurg.2020.11.027

Park HS, Hong N, Jeong JJ, Yun M, Rhee Y. Update on preoperative parathyroid localization in primary hyperparathyroidism. Endocrinol Metabol. 2022;37(5):744-55. DOI: https://doi.org/10.3803/EnM.2022.1589

Downloads

Published

2025-02-28

How to Cite

Pal, B., & Jha, H. N. (2025). Optimizing surgical outcomes through preoperative parathyroid localization. International Journal of Research in Medical Sciences, 13(3), 1238–1245. https://doi.org/10.18203/2320-6012.ijrms20250694

Issue

Section

Systematic Reviews