THE IMPORTANCE OF PREOPERATİVE IMAGİNG İN THE MANAGEMENT OF ECTOPİC PARATHYROİD ADENOMAS
Abstract
Objective:Ectopic parathyroid adenomas represent a small but clinically challenging subset of primary hyperparathyroidism (PHPT), often leading to failed exploration when preoperative localization is inadequate. This study aimed to evaluate the contribution of preoperative imaging strategies to surgical planning and outcomes in patients with ectopic parathyroid adenomas.Materials and Methods:A retrospective analysis was performed on patients who underwent parathyroidectomy for PHPT at a single tertiary center between January 2021 and March 2024. Among 83 operated patients, 16 with ectopic parathyroid adenomas confirmed by preoperative imaging and histopathology were included. Demographic characteristics, biochemical findings, imaging results, surgical approaches, and postoperative outcomes were reviewed.Results:The study cohort consisted of 12 women and 4 men with a mean age of 55 ± 12 years (range, 34–72). Mean preoperative serum calcium and parathyroid hormone levels were 11.8 ± 0.6 mg/dL and 287 ± 95 pg/mL, respectively. All patients underwent cervical ultrasonography (US) and Tc-99m sestamibi scintigraphy combined with SPECT-CT. Sestamibi scintigraphy correctly localized ectopic adenomas in 87.5% of cases (14/16), whereas US was accurate in 50% (8/16). In three patients with negative or equivocal first-line imaging findings, four-dimensional computed tomography (4D-CT) was performed and successfully localized the lesions. The most frequent ectopic location was the tracheoesophageal groove (31.25%). Surgical cure was achieved in all patients, and no permanent postoperative complications were observed.Conclusion:Accurate preoperative localization plays a pivotal role in the surgical management of ectopic parathyroid adenomas. The combined use of cervical ultrasonography and sestamibi scintigraphy/SPECT-CT provides high diagnostic yield, while 4D-CT offers valuable additional information in selected patients with inconclusive findings, facilitating targeted surgery and avoiding unnecessary extensive exploration.