Assessment of techniques for preoperative parathyroid gland localization in patients undergoing reoperation for hyperparathyroidism

Persistent and recurrent hyperparathyroidism after previous unsuccessful surgery is a major problem for the patient and the physician. We have prospectively evaluated the ability of cineesophagography, computed tomography, selective venous sampling for parathyroid hormone, and selective arteriography to preoperatively detect parathyroid tissue in 75 patients undergoing reoperation. The invasive studies were routinely and safely applied to all patients in an effort to determine their value. In 55% of studies performed, preoperative localization by selective venous sampling was consistent with the subsequent operative findings. Selective arteriography correctly localized abnormal parathyroid tissue in 49% of studies performed but was more specific than selective venous sampling. Cine-esophagography was not of help in localization but did demonstrate abnormalities of swallowing attributed to prior surgery. Computed tomography correctly localized 11% of patients studied.