Evaluating the Combined Approach of Three Intra-Operative Adjuncts in Localising Parathyroid Adenomas During Minimally Invasive Radio-Guided Parathyroidectomy: A Single Centre Retrospective Analysis

Purpose: Our study aims to critically evaluate the combined use of intra-operative parathyroid hormone (ioPTH) assay testing, frozen section analysis and ex vivo specimen radio-activity using the ‘Norman 20% radio-activity rule.’ Methods: A single-centre, retrospective analysis of intra-operative adjuncts used in minimally invasive radio-guided parathyroidectomy. ioPTH assay, ex vivo specimen radio-activity using the ‘Norman 20% radio-activity rule’ and frozen section analysis were analysed to determine the sensitivity of each adjunct. The final histopathological diagnosis was also analysed. Results: The sensitivity of ioPTH assay, ‘Norman 20% radio-activity rule’ and frozen section analysis in the detection of parathyroid adenomas is 96.1%, 96.1% and 100%, respectively. When all 3 adjuncts are utilised intra-operatively, parathyroid adenomas are correctly identified in 97% of cases. Conclusion: The use of 3 intra-operative adjuncts in conjunction with one another during minimally invasive parathyroidectomy surgery leads to a high rate of the successful detection of parathyroid adenomas as confirmed by histopathological diagnosis.