Clinical Characterization of a Large Cohort of Primary Hyperparathyroid Filipino Patients who underwent Parathyroidectomy and the Accuracy of Preoperative Parathyroid Localization Studies used at a Multispecialty Tertiary Hospital in Manila, Philippines
Background: Philippine data on demographics and clinical profiles of primary hyperparathyroidism (pHPT) are scarce and the advancement to minimally invasive parathyroidectomies with better outcomes require accurate localization imaging.1,2 However, due to inadequate local data, recognition of disease and progression to more minimally invasive parathyroid surgeries in the Philippines are particularly difficult.
Objective: To characterize Filipino patients seen at The Medical City diagnosed with pHPT who underwent parathyroidectomy and determine the sensitivity and specificity of current preoperative localization imaging modalities, ultrasound (UTZ) and 99mTc-MIBI scan.
Methodology: A retrospective cross-sectional study of Filipino patients with pHPT who underwent parathyroidectomy at The Medical City from January 2004 to August 2018 was conducted. Demographic profile, clinical and biochemical presentations were described and compared with international data. Diagnostic accuracy test was used to determine the sensitivity and specificity of UTZ and 99mTc-MIBI scan.
Results: 35 patients were included in the analysis with female predominance (2:1) and an average age of 53 years. Prevailing manifestations and indications for surgery were skeletal abnormalities (51%), renal calculi (49%) and nonspecific gastrointestinal (49%) and musculoskeletal (43%) symptoms, similar to India, Saudi Arabia and Thailand. This is contrast to data from America and Europe those with evident symptoms compose less than 20% of patients.3,4 Adenomas are the most common pathology at 86.1%. Sensitivity of UTZ was 51.5% while 99mTc-MIBI scan was 87.9%. Specificity was 96.8% for UTZ and 80% for 99mTc-MIBI scan. Data suggests multinodular goiter contributes to the difficulty in parathyroid localization with UTZ vs 99mTc-MIBI scan (56% vs 88%). Combined sensitivity, specificity and accuracy are at 93.5%, 83.9% and 88.7% respectively, as opposed to individual accuracies of 73.4% for UTZ and 83.8% for 99mTc-MIBI scan.Conclusion: Our population demonstrates comparable presentations, as well as surgical indications, with our neighboring Asian countries which are predominantly of symptomatic disease as opposed to more asymptomatic surgical patients in developed countries. With high specificity, a positive UTZ result alone may be sufficient as a preoperative localization modality, but a negative UTZ result would require adding a sestamibi scan. Nonetheless, performing both is recommended whenever able in order to give the best preoperative localization accuracy especially in patients with nodular goiter to aid in more minimally invasive surgeries.
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