12. A Comprehensive Evaluation Of Peri-Operative Adjuncts During Minimally Invasive Parathyroidectomy: Which Is Most Reliable?
Herbert Chen, MD*†, James R. Starling, MD, Eberhard Mack, MD*
University of Wisconsin, Madison, WI

Objectives Minimally invasive parathyroidectomy (MIP) is rapidly becoming the procedure of choice in patients with primary hyperparathyroidism (HPT). Several peri-operative adjuncts can be utilized to localize parathyroid adenomas including sestamibi-SPECT scanning, radioguided surgery, and intraoperative parathyroid hormone (ioPTH) testing. However, the relative value of each of these technologies is unclear.
Methods Between 3/01-9/04, 254 patients with primary HPT underwent parathyroidectomy. All patients had pre-operative imaging studies and underwent radioguided surgery with a gamma probe and ioPTH testing. The utility of each peri-operative adjunct was determined based upon the intraoperative findings.
Results. The mean age of patients was 61±1 years. All had elevated calcium (mean=11.4±0.1 mg/dl) and parathyroid hormone (mean=136±6 pg/ml) levels. Of the 254 patients, 206 (81%) had a single parathyroid adenoma, 28 (11%) had double adenomas, 19 (8%) had hyperplasia, and 1 had parathyroid cancer. All resected parathyroid glands were hypercellular (mean weight=895 ±86 mg). The cure rate after parathyroidectomy was 98%.

	Sensitivity	Positive-Predictive Value	Accuracy
Sestamibi scanning	84%	81%	72%
Radioguided surgery	93%	88%	83%
ioPTH testing	99%	99.6%	98%

Conclusions This series is the largest to date, which directly compares the utility of sestamibi scanning, radioguided surgery, and ioPTH testing. Of all the peri-operative adjuncts utilized during parathyroid surgery, ioPTH testing has the highest sensitivity, positive-predictive value, and accuracy. Thus, the inherent variability of sestamibi scanning and radioguided techniques emphasizes the critical role of ioPTH testing during parathyroid surgery.

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