Impact of Localization Studies and Clinical Scenario in Patients With Hyperparathyroidism Being Evaluated for Reoperative Neck Surgery | Congenital Defects | JAMA Surgery | JAMA Network
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Original Article
Dec 2011

Impact of Localization Studies and Clinical Scenario in Patients With Hyperparathyroidism Being Evaluated for Reoperative Neck Surgery

Author Affiliations

Author Affiliations: Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio.

Arch Surg. 2011;146(12):1397-1403. doi:10.1001/archsurg.2011.837
Abstract

Background Previous studies have focused on the success of localization studies (LSs) in patients undergoing reoperative parathyroid surgery; however, patients who did not undergo reexploration surgery have been excluded from analysis. In addition, the concept of whether clinical scenario (CS) suggests single- vs multiple-gland disease in reoperative strategy is often underemphasized.

Objective To evaluate how LSs and CS direct operative strategy in patients being considered for reexploration.

Design Retrospective review of a prospective database.

Setting Tertiary referral center.

Patients Two hundred three patients with hyperparathyroidism who underwent previous neck surgery. The CS stratified patients as candidates for single- or multiple-site exploration (or unknown).

Main Outcome Measure Ability of CS and LSs to direct successful reexploration.

Results Of 203 patients, 27 were not explored owing to nonlocalizing studies. Of the remaining 176 patients, LSs accurately guided reexploration in 85%. However, when including the 27 nonexplored patients, the success of LSs decreased to 73%. The cure rate in reoperated patients was 96% but was reduced to 83% when including nonexplored patients. Of the reoperated patients, 83% had single-site disease and 17% had multiple-site disease. The positive predictive value of LSs in predicting single- or multiple-site disease was 92% and 73%, respectively. However, when stratified by CS, the positive predictive value increased to 95% for single-site disease and to 100% for multiple-site disease.

Conclusions Failure to cure patients was 4 times more likely to be due to nonlocalizing studies than to a failed reexploration. Stratification by CS was useful in the interpretation of LSs and in determining the most accurate reoperative approach.

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