There were and are no policies at our institution regarding the extent of neck exploration, preoperative localization studies, and intraoperative parathyroid staining. Certain preoperative localization imaging studies performed because of favorable reports were subsequently discontinued because of less satisfactory local experience. Preoperative localization before parathyroid neck exploration has been controversial for the past 20 years. The debate surrounding preoperative localization continues as different studies are evaluated or modified. Numerous reports have shown preoperative localization to be useful.
Similar limitations exist for sestamibi scan.
CT and MRI of the neck are less sensitive and more expensive in comparison with sestamibi scan. Specifically, a technique does not exist for parathyroid disease that provides the combination of low cost, noninvasiveness, high sensitivity, high specificity, and decrease in overall operative time. Today, the sestamibi scan is accepted as the most reliable preoperative localization study. This review demonstrates that when preoperative localization studies were used, an abnormal parathyroid was correctly identified in 75 per cent of patients. Many experienced surgeons believe preoperative localization is unnecessary and costly for primary neck exploration.