Location, location, location.

Abstract

The essence of parathyroid surgery is finding the diseased gland or glands. Even the most experienced parathyroid surgeons have a finite, albeit small, miss rate. The information above shows that there has been, over the years, a significant amount of effort expended to find a way to localize the glands in reliable fashion. Although current parathormone assays are virtually certain to identity the disease, available localization studies still miss a sizable number of lesions, and the statement, "The best way of localizing the parathyroid glands is to localize an experienced parathyroid surgeon," probably remains valid. Does such a surgeon need an ultrasound or sestamibi scan preoperatively? Probably not. I would note, however, that many such surgeons have written of their experience with these localization studies, suggesting that they usually operate with this information available to them. In the managed care era, with many of these procedures being done by less frequent parathyroid surgeons despite the failure of currently available studies to show any advantage in operative time or success, the high positive predictive value of the sestamibi scan in particular can, I think, be very helpful in focusing the procedure. Certainly, the patient should not be denied this advantage by cost issues, which in this uncommon disease only serve to benefit the balance sheet of the managed care organization.