Impact on surgery of preoperative localization of parathyroid lesions with dual radionuclide subtraction scanning.

In an effort to localize parathyroid lesions preoperatively, scanning with radioactive thallium and technetium was performed in 20 patients considered clinically to have hyperparathyroidism. In the 11 found at surgery to have single parathyroid adenomas, scanning correctly localized the lesion in 10; in the other patient the lesion was in the unscanned mediastinum. Preoperative scanning was not as rewarding in the seven patients with parathyroid hyperplasia. A thyroid lesion was the source of an abnormality seen on the parathyroid scan in one patient, while neck scanning and surgical exploration were negative in another. Comparison of the patients who had parathyroid adenomas localized in the neck with a control group of similar patients who did not undergo preoperative scanning showed that the average surgical time was reduced by 50% with preoperative localization and there was a decrease in the number of nonparathyroid tissue biopsies.