Primary hyperparathyroidism (PHPT) remains a challenging condition requiring accurate preoperative localization for effective surgical management. Minimally invasive parathyroidectomy has become the preferred approach due to its benefits in reducing postoperative pain, improving cosmetic outcomes, and increasing patient satisfaction. However, success hinges on precise identification of pathological parathyroid glands prior to surgery. Traditional imaging modalities such as 4D-CT and Tc-99m sestamibi scintigraphy have shown variable diagnostic performance, particularly in cases involving small or ectopically located adenomas. This study evaluates the role of 3-dimensional virtual neck exploration (3D-VNE), a novel technique based on CT data, in enhancing localization accuracy.
A cohort of 235 consecutive patients with biochemically confirmed PHPT was analyzed between January 2014 and December 2018, with a minimum 6-month follow-up. Of these, 220 underwent preoperative CT scans, 172 received 3D-VNE based on those scans, and 226 had Tc-99m sestamibi scans. Diagnostic accuracy was assessed using operative findings as the gold standard. The sensitivity for exact, per-gland localization was significantly higher with 3D-VNE at 90.21% (95% CI: 85.21–93.64%) compared to 57.09% for CT scan alone (P < 2.2 × 10⁻¹⁶) and 58.17% for sestamibi scans (P = 3.1 × 10⁻¹⁵). Specificity was comparable across all modalities—87.38% for CT, 86.36% for 3D-VNE, and 90.00% for sestamibi scans—with no statistically significant differences. The use of 3D-VNE enabled more accurate identification of anatomical variations such as nonrecurrent laryngeal nerves and multiglandular disease, which influenced surgical planning. It also reduced the need for conversion from minimally invasive approaches to bilateral exploration. Only 16.5% of video-assisted parathyroidectomies required conversion, primarily due to technical challenges rather than imaging failure. Notably, the recurrence rate was significantly lower in the video-assisted group (1.324%) compared to conventional cervicotomy (5.952%), underscoring the long-term benefits of targeted surgery guided by high-accuracy imaging. All patients achieved biochemical cure, with a 100% normalization of serum calcium and PTH levels postoperatively.CREB-1 Antibody Description The overall recurrence rate was 2.IDH2 Antibody MedChemExpress 978%, with the lowest rate observed in patients who underwent both 3D-VNE and sestamibi scanning (1.PMID:34846694 840%). These findings highlight the value of integrating advanced imaging into clinical workflow.
In conclusion, CT-based 3D-VNE emerges as the most accurate preoperative localization tool for parathyroid adenomas. Its ability to improve surgical precision supports its adoption as a first-line imaging modality in PHPT. By enabling safer, more targeted interventions, 3D-VNE enhances patient outcomes while minimizing unnecessary dissection and complications. Future integration with functional imaging and AI-driven segmentation may further refine this technology, making it a cornerstone in the surgical management of primary hyperparathyroidism.MedChemExpress (MCE) offers a wide range of high-quality research chemicals and biochemicals (novel life-science reagents, reference compounds and natural compounds) for scientific use. We have professionally experienced and friendly staff to meet your needs. We are a competent and trustworthy partner for your research and scientific projects.Related websites: https://www.medchemexpress.com