Localization Studies

As discussed in Chapter 46, localization studies are rarely ever necessary in primary operations for PHPT, whereas they are usually considered mandatory in reoperative cases regardless of the cause of the lesion. Doppman23 and Kaplan and colleagues24 rightly argued that the best localization

TABLE 63-1. Incidence of Parathyroid Carcinoma

No. of Cases

Carcinoma

No. of Cases

with Parathyroid

Incidence

Author, Year

Time Period

with PHPT

Carcinoma

<%)

Van Heereden et al, 1979

1928-1977

2013

12

0.6

Wang and Gaz, 198517

1948-1983

1200

28

2.3

Smith and Coombs, 1984s

1951-1981

678

20

2.9

Fujimoto et al, 1984

1967-1982

165

7

4.6

Cohn et al, 1985

1942-1984

310

9

3

Mattei et al, 1988

1956-1984

528

12

2.3

Palnaes Hansen et al, 1991

1963-1990

700

8

1.1

ShorteU et al, 199119

1958-1990

197

11

5.6

Sandelin et al, 199125

1973-1990

1650

6

0.3

PHPT - primary hyperparathyroidism.

procedure is to find an excellent parathyroid surgeon. Ultrasonography, computed tomography (CT), magnetic resonance imaging, and scintigraphy with thallium or sestamibi all are highly efficient in the hands of a skilled operator. An additional advantage of ultrasonography is that it can be used during the operation, when it can relate the tumor to adjacent anatomic structures. For localization of recurrences or metastatic spread, a CT scan of the mediastinum, lungs, and abdomen may be of value in detecting mediastinal, lung, and liver metastases. Selective venous sampling for PTH, including distant samplings of iliac veins, may even detect remote lesions.25 In combination with any of the noninvasive techniques, it regionalizes the area of maximum secretion of PTH. A previous thyroid lobectomy affects the venous drainage and should be considered in evaluating the results of the venous sampling.23

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