چکیده (انگلیسی):

Introduction: An accurate differential diagnosis between single adenoma (SA) and multiglandular disease
(MGD) remains difficult in Technetium-99m sestamibi scintigraphy (MIBI)-negative patients with primary
hyperparathyroidism (PHPT). The aim of the present study was to evaluate the minimally invasive
parathyroidectomy (MIP) in patients with PHPT.
Methods: Clinical records of 48 patients who underwent neck exploration between November 2002 and
June 2012 in Kochi Medical School Hospital were reviewed retrospectively to identify candidates that
underwent for MIP which was defined as the selective removal of a SA using less invasive surgery.
Results: The preoperative detection rate of lesions using ultrasonography, MIBI, computed tomography,
and magnetic resonance imaging was 90%, 83%, 76%, and 55%, respectively. Although all 39 patients in
the MIBI-positive group were diagnosed with an SA and subsequently underwent curative MIP, 3 patients
in MIBI-negative group (n ¼ 6) were MGD, who underwent neck exploration. Preoperative mean intact
parathyroid hormone (419 pg/ml vs. 149 pg/ml; P < 0.01) and alkaline phosphatase levels (746 U/l vs.
277 U/l; P < 0.01) were significantly higher in the SA than MGD group.
Conclusions: In MIBI-negative patients with indications for surgery, MIP should not be carried out
without a clear localization of SA, or in MGD.