Computed tomography can guide focused exploration in select patients with primary hyperparathyroidism and negative sestamibi scanning.

BACKGROUND: The aim of this study was to analyze the utility of preoperative thin cut (2.5 mm) computed tomography (CT) in patients with primary hyperparathyroidism (PHPT) and negative sestamibi scans.

METHODS: A retrospective review of patients with PHPT was conducted from the prospective parathyroid registries of 2 tertiary referral centers. Of 482 patients, 63 with negative sestamibi scanning underwent thin cut CT of the neck and were included in the final analysis.

RESULTS: CT was 85% sensitive and 94% specific for correctly lateralizing the side(s) of diseased glands and 66% sensitive and 89% specific for predicting exactly the location of diseased glands. Sixty-six percent of patients underwent focused explorations, and 87% of patients underwent parathyroidectomy under local anesthesia. Pathology revealed a single adenoma in 83%, multigland disease in 14%, carcinoma in 1%, and no pathology in 2%. Average operative time was 73 minutes overall, but only 55 minutes in patients with precise CT localization (P = .02).

CONCLUSION: Thin cut CT is a helpful adjunct to preoperative workup in PHPT patients who have negative sestamibi localization and permits a focused neck exploration in a high percentage of those patients.