Unravelling Preoperative and Intraoperative Parathyroid Adenoma Localization (PIPAL Study)—From a high-volume tertiary care centre in India

Purpose: To describe the clinical profile of patients with parathyroid adenoma and evaluate various diagnostic and localization methods. Additionally, to assess the effectiveness of intraoperative parathyroid hormone (PTH) assay in confirming successful adenoma excision, compared to conventional frozen section analysis. Methods: This observational study was conducted at a tertiary care hospital in Southwestern India, involving 60 patients diagnosed with parathyroid adenoma who underwent parathyroidectomy between January 2013 and July 2018. Demographic, clinical, and biochemical data were collected. Ultrasonography (USG) of the neck and/or Technetium-99 m sestamibi scan were utilized for preoperative localization of the adenoma. Intraoperatively, confirmation of successful excision was achieved using frozen section and/or intraoperative PTH assay. Results: The most common age group for presentation was 51–60 years, with a slight male predominance. The predominant clinical manifestation was musculoskeletal symptoms (41.6%), followed by acute pancreatitis (23.3%) and renal calculi (20%). Preoperative localization using ultrasonography had a sensitivity of 75.9%, while the sestamibi scan demonstrated a sensitivity of 96.3%. When both modalities were used in combination, the sensitivity reached 100%. To confirm successful adenoma excision, frozen section had a sensitivity of 86%, whereas intraoperative PTH assay demonstrated a higher sensitivity of 96.9%. Conclusions: Technetium-99 m sestamibi scanning is more sensitive than neck ultrasonography for localizing parathyroid adenomas. The combination of both modalities significantly enhances diagnostic accuracy. Intraoperative PTH assay is highly effective in confirming successful adenoma excision and may potentially replace the need for conventional frozen section analysis.