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The localization of 10% of the pathologic glands in secondary Hyperparathyroidism depends on the surgeon experience
Authors: José Luis D’Addino
Number of views: 438
Methods for preoperative localization of parathyroidin secondary hyperparathyroidism are controversial
in the literature and have different and dissimilar sensitivity. With the objective to determine the correlation
between preoperative ultrasound, scintigraphy MIBI and intraoperative findings in secondary hyperparathyroidism
we review our 10 years statistic.Between2004-2014, 100 patients underwent parathyroidectomy due to secondary
hyperparathyroidism. Data obtained from medical records included: preoperative serum parathormona, ultrasound,
scintigraphy. Positive predictive value and negative predictive value were analyzed in correlation with intraoperative
findings.The method of calculation of ROC curves and area under the curve and other screening values
(confidence index, index of validity and likelihood ratio) were used. 68% were women; mean age was 52,7
years. Mean PTH value was 1486 pg/ml. The specificity and sensitivity of preoperative ultrasound were 94,44%
and 30,14%, respectively. PPV was 93,62% and NPV was 33,33%. For scintigraphy, the sensitivity was 25,34%,
specificity 98,15%, PPV was 97,37% and NPV was 32,72%. The ultrasound diagnosed 94 glands among a possibility
of 400, the scintigraphy showed 76 and the surgery founded 292. Recurrence, 22%. Ultrasound and scintigraphy allow
the localization of pathological parathyroid; however, in 10% of cases,glands could not be detected preoperatively,
making surgeons experience fundamental in gland localization.