{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T03:14:39Z","timestamp":1771470879475,"version":"3.50.1"},"reference-count":25,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nuklearmedizin"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Aim In patients with recurrent primary hyperparathyroidism (pHPT) or preceding thyroid operation, scintigraphic localization of the pathological parathyroid gland is sometimes unsuccessful. Reason for diagnostic failure, and its clinical relevance is poorly understood.<\/jats:p><jats:p>\n          Methods This retrospective observational study in patients suffering from a pHPT evaluated independent predictors of a negative preoperative scintigraphy (SC) result, and its relevance for intraoperative outcome using logistic regression analysis.<\/jats:p><jats:p>\n          Results Among 86 pHPT patients scheduled for parathyroid operation, 63 (73%) had a history of a preceding thyroid or parathyroid operation. Preoperative SC could not identify an adenoma in 30 patients (34.9%), and in 12 patients (14.0%), the surgeon was subsequently unable to localize abnormal parathyroid tissue. Preoperative parathyroid hormone concentration was the only significant independent predictor of a negative SC finding (non-linear and indirect association). Independent from surgical history, an unsuccessful intraoperative focus localization was exclusively predicted by preoperative ultrasonographic (US) and SC findings (OR per diagnostic category 2.98; 95%-CI 1.03\u20138.58, p=0.043, and OR 2.26; 95%-CI: 1.10\u20134.63, p=0.027, respectively). Compared to exclusive US, however, the combination of SC and US significantly increased the sensitivity and predictive power to identify patients at a high risk for a complicated surgical procedure.<\/jats:p><jats:p>\n          Conclusion In patients before parathyroidectomy, a low preoperative parathyroid hormone concentration is significantly associated with a high likelihood for a negative SC finding. Combining US with SC before operation significantly increases the chance to identify patients prone to negative intraoperative findings.<\/jats:p>","DOI":"10.1055\/a-1868-5050","type":"journal-article","created":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T12:14:10Z","timestamp":1659356050000},"page":"440-448","source":"Crossref","is-referenced-by-count":4,"title":["Determinants and clinical significance of negative scintigraphic findings in primary hyperparathyroidism: a retrospective observational study"],"prefix":"10.1055","volume":"61","author":[{"given":"Michael","family":"Neuberger","sequence":"additional","affiliation":[{"name":"M\u00fcnchen, Klinik f\u00fcr Allgemeine, Viszeral- und Transplantationschirurgie, Klinikum der Universit\u00e4t M\u00fcnchen, M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan Axl","family":"Dropmann","sequence":"additional","affiliation":[{"name":"M\u00fcnchen, Klinik f\u00fcr Allgemeine, Viszeral- und Transplantationschirurgie, Klinikum der Universit\u00e4t M\u00fcnchen, M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axel","family":"Kleespies","sequence":"additional","affiliation":[{"name":"HELIOS Amper-Klinikum Dachau, Dachau, Germany"},{"name":"M\u00fcnchen, Klinik f\u00fcr Allgemeine, Viszeral- und Transplantationschirurgie, Klinikum der Universit\u00e4t M\u00fcnchen, M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heinrich","family":"Fuerst","sequence":"additional","affiliation":[{"name":"Chirurgische Klinik, Krankenhaus Martha-Maria Munchen, M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,7,29]]},"reference":[{"key":"ref2","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/j.otohns.2004.10.005","article-title":"A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003","volume":"132","author":"JM Ruda","year":"2005","journal-title":"Otolaryngol Head Neck Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1016\/S1072-7515(03)00676-8","article-title":"Accuracy of preoperative localization studies and intraoperative parathyroid hormone assay in patients with primary hyperparathyroidism and double adenoma","volume":"197","author":"M Haciyanli","year":"2003","journal-title":"J Am Coll Surg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1097\/01.MLG.0000203411.53666.AD","article-title":"Impact of gland morphology and concomitant thyroid nodules on preoperative localization of parathyroid adenomas","volume":"116","author":"Y Erbil","year":"2006","journal-title":"Laryngoscope"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1097\/SLA.0b013e3181859f71","article-title":"Predicting the success of limited exploration for primary hyperparathyroidism using ultrasound, sestamibi, and intraoperative parathyroid hormone: analysis of 1158 cases","volume":"248","author":"A Siperstein","year":"2008","journal-title":"Ann Surg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"133","DOI":"10.23736\/S0391-1977.17.02685-2","article-title":"Imaging in primary hyperparathyroidism: focus on the evidence-based diagnostic performance of different methods","volume":"43","author":"G Treglia","year":"2018","journal-title":"Minerva Endocrinol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1001\/archotol.131.6.493","article-title":"Relationship of technetium Tc 99m sestamibi scans to histopathological features of hyperfunctioning parathyroid tissue","volume":"131","author":"NY Mehta","year":"2005","journal-title":"Arch Otolaryngol Head Neck Surg"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1677\/erc.0.0100419","article-title":"Hyperfunctioning parathyroid tumours in patients with thyroid nodules. Sensitivity and positive predictive value of high-resolution ultrasonography and 99mTc-sestamibi scintigraphy","volume":"10","author":"F Lumachi","year":"2003","journal-title":"Endocr Relat Cancer"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1016\/s0194-5998(00)70013-1","article-title":"Relation of biochemical, cytologic, and morphologic parameters to the result of gammagraphy with technetium 99m sestamibi in primary hyperparathyroidism","volume":"122","author":"A Pinero","year":"2000","journal-title":"Otolaryngol Head Neck Surg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1573","DOI":"10.1007\/s002680010280","article-title":"Preoperative localization of parathyroid adenoma in patients with concomitant thyroid nodular disease","volume":"24","author":"Y Krausz","year":"2000","journal-title":"World J Surg"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1016\/j.amjoto.2004.03.006","article-title":"Synchronous thyroid pathology in patients presenting with primary hyperparathyroidism","volume":"25","author":"KS Beus","year":"2004","journal-title":"Am J Otolaryngol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1373","DOI":"10.1016\/s0895-4356(96)00236-3","article-title":"A simulation study of the number of events per variable in logistic regression analysis","volume":"49","author":"P Peduzzi","year":"1996","journal-title":"J Clin Epidemiol"},{"key":"ref13","first-page":"255","volume-title":"Parathyroid growth: normal and abnormal","author":"D Rao","year":"2016"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"104","DOI":"10.2967\/jnmt.111.098400","article-title":"Parathyroid imaging: the importance of dual-radiopharmaceutical simultaneous acquisition with 99mTc-sestamibi and 123I","volume":"40","author":"SA Caveny","year":"2012","journal-title":"J Nucl Med 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Hosmer","year":"1989"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1494","DOI":"10.1007\/s00268-017-3891-0","article-title":"Is Unilateral Neck Surgery Feasible in Patients with Sporadic Primary Hyperparathyroidism and Double Negative Localisation?","volume":"41","author":"DM Scott-Coombes","year":"2017","journal-title":"World J Surg"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1097\/01.sla.0000234899.93328.30","article-title":"Remedial parathyroid surgery: changing trends in 130 consecutive cases","volume":"244","author":"R Udelsman","year":"2006","journal-title":"Ann Surg"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1007\/s00268-008-9537-5","article-title":"High success rate of parathyroid reoperation may be achieved with improved localization diagnosis","volume":"32","author":"O Hessman","year":"2008","journal-title":"World J 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