Pre-operative diagnosis of Parathyroid Cancer: a single centre experience


P Klang, G Galata’, N Talat, N Anscomb, A Al-Lawati, KM Schulte,

Department of Endocrine and General Surgery, King’s College Hospital, London,

Department of Surgery, Australian National University, Canberra, Australia.



Background: Parathyroid Cancer is a rare condition (<3% of patients diagnosed with Primary Hyperparathyroidism). Under staging and under treatment of parathyroid cancer can have disastrous consequences for patients. The risk of local recurrence, distal metastases and death is estimated as double of those initially diagnosed and treated appropriately. 


Objective: This study shows the experience of a single centre in London with the objective of demonstrating and highlighting the importance of preoperative diagnosis, staging and initial treatment of this rare and aggressive disease, by showing the difference and improved outcomes for patients appropriately staged and treated. It also highlights the importance of simple recognition tools such as the Schulte’s 3 + 3 rule for suspicion of Parathyroid Cancer. 


Design and methods: Retrospective single centre review. The data consists of patients whom underwent oncological Parathyroidectomy between 2005 and 2018 at King’s College Hospital. SPSS software was used for analysis


Results: 28 patients were included in the study: 8 patients underwent local excision and 20 underwent oncological resection (unilateral en bloc resection of thyroid lobe, both parathyroids and level VI lymphadenectomy). 3 patients who underwent local excision elsewhere had local recurrence and were referred to our centre for further treatment. One patient with pre-operative lung metastases, underwent oncological resection had also local recurrence and died after 12 years follow up. Twenty-four patients are free of disease. Average pre-operative Calcium was 3.01nmol/L, PTH 287ng/L and size 36mm.


Conclusion: Under staging and under treatment leading to inappropriate initial management showed a 12-fold increase in recurrence rates. The only observed recurrence in patients that underwent initial EB resection was related to advance staging due to distant metastasis. This highlights the importance of recognising pre-operative indicative factors described above for appropriate surgical planning, reducing risk of recurrence and death.