Impact of localization studies and clinical scenario in patients with hyperparathyroidism being evaluated for reoperative neck surgery

Joyce J. Shin, Kresimira Milas, Jamie Mitchell, Eren Berber, Louis Ross, Allan Siperstein

Research output: Contribution to journalArticle

16 Citations (Scopus)

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 multiplesite 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.

Original languageEnglish (US)
Pages (from-to)1397-1403
Number of pages7
JournalArchives of Surgery
Volume146
Issue number12
DOIs
StatePublished - Dec 2011
Externally publishedYes

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Hyperparathyroidism
Neck
Clinical Studies
Tertiary Care Centers

ASJC Scopus subject areas

  • Surgery

Cite this

Impact of localization studies and clinical scenario in patients with hyperparathyroidism being evaluated for reoperative neck surgery. / Shin, Joyce J.; Milas, Kresimira; Mitchell, Jamie; Berber, Eren; Ross, Louis; Siperstein, Allan.

In: Archives of Surgery, Vol. 146, No. 12, 12.2011, p. 1397-1403.

Research output: Contribution to journalArticle

Shin, Joyce J. ; Milas, Kresimira ; Mitchell, Jamie ; Berber, Eren ; Ross, Louis ; Siperstein, Allan. / Impact of localization studies and clinical scenario in patients with hyperparathyroidism being evaluated for reoperative neck surgery. In: Archives of Surgery. 2011 ; Vol. 146, No. 12. pp. 1397-1403.
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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 multiplesite 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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