Scripties UMCG - Rijksuniversiteit Groningen
English | Nederlands

Efficiency of Preoperative Imaging Workup to Facilitate a Focused Approach in Patients with Primary Hyperparathyroidism.

(2018) Brands, S.

Objective: To analyze the preoperative imaging workup for patients with primary hyperparathyroidism (PHPT) before parathyroid surgery and identify the relationship with the execution of a focused approach.
Background: PHPT is a endocrine disorder caused by overactive parathyroid glands producing parathyroid hormone. Surgery is the only curative treatment for PHPT and consists of two methods: a focused approach (i.e. minimal invasive parathyroidectomy) or a bilateral neck exploration. To facilitate a focused approach preoperative imaging is necessary to identify the parathyroid adenoma at the correct location and anatomical side. Various imaging modalities are available. Therefore, in 2016 a guideline was published by the American Association of Endocrine Surgeons (AAES) for the preoperative imaging workup. However, in The Netherlands a guideline for this preoperative imaging workup is not (yet) available. Therefore, currently it is unclear how this preoperative workup is managed in the hospital environment in The Netherlands.
Methods: 112 patients with PHPT who underwent parathyroidectomy between 2007 and 2017 were included for this retrospective cohort study. Relationship between preoperative imaging workup and type of approach was analyzed with multiple logistic regression. Further patient characteristics, operative- and pathologic findings were compared between the two approaches.
Results: 56 patients had preoperative imaging workup by the AAES-guideline and 56 patients had other preoperative imaging workup. 49 (88%) patients in the AAES-guideline group had a focused approach compared to 37 (66%) patients in the non-guideline group (p=0.009). The use of the AAES-guideline was a significant predictor for a focused approach (odds ratio 5.15 (p=0.006)).
Conclusion: 50% of patients had preoperative imaging according to the most recent AAES-guideline. This preoperative imaging workup was highly associated with a focused approach and could help physicians requesting localizing imaging modalities.

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