Can Imaging Studies Be Routinely Omitted In Patients With Sporadic Primary Hyperparathyroidism Without a History of Neck Surgery?

ObjectiveTo evaluate whether omission of routine preoperative imaging would affect efficiency or safety for parathyroidectomy. Methods As part of our clinical practice, we began a non-imaging protocol for patients with the... [ view full abstract ]

Objective
To evaluate whether omission of routine preoperative imaging would affect efficiency or safety for parathyroidectomy.

Methods
As part of our clinical practice, we began a non-imaging protocol for patients with the diagnosis of sporadic primary hyperparathyroidism.  If the patient did not have preoperative parathyroid imaging before evaluation by a surgeon, no radiologic studies were ordered and the patient was consented for parathyroidectomy.  From 2000-2015, 83 patients underwent parathyroidectomy without imaging compared to 1,245 patients who had imaging (sestamibi, ultrasound, or CT) prior to surgery.  We used propensity matching to address differences between the imaging and no imaging groups.

Results  
We matched 64 patients with no preoperative imaging to equivalent patients who had imaging prior to surgery.  Median age was 60 years, 84% were women, and median preoperative calcium was 10.4 mg/dl.  There was no significant difference in operative time between patients with and without preoperative imaging (84 minutes for both groups, p<0.32).  Intraoperative parathyroid hormone levels dropped by at least 50% in all patients without preoperative imaging and in 98% of patients with imaging (p<0.24).  Neither group demonstrated recurrences six months after surgery.  Overall complication rates in the no imaging (5%) and the imaging group (11%) were also similar (p<0.18).

Conclusions  
Parathyroid surgery without preoperative imaging is safe, effective and offers equivalent outcomes compared to an approach based on routine preoperative imaging.  Experienced surgeons can consider omitting preoperative imaging in patients without a history of neck surgery as this may reduce overall treatment costs.