Accuracy of surgeon-performed ultrasound in parathyroid localization.
ABSTRACT Ultrasound is one of the preferred modalities for localization of abnormal parathyroids. Accuracy of ultrasound is technician-dependent. This study was undertaken to determine the accuracy of surgeon-performed ultrasound (SPU) for the localization of parathyroid tumors in comparison to radiology-performed ultrasound (RPU) and nuclear scintigraphy (NS). In this series 74 consecutive patients with untreated primary hyperparathyroidism underwent SPU at the initial clinic visit; 21 of these patients did not undergo surgery and are excluded from the analysis. Of the 53 patients remaining, RPU was obtained in 26, and 52 patients underwent NS. Directed parathyroidectomy was performed with use of the intraoperative parathyroid hormone assay (IOPTH). In all, 46 patients had a single adenoma as indicated by IOPTH and final pathology. Two patients had double gland disease, and 5 patients had multi-gland hyperplasia. The sensitivity of SPU was 82% and the specificity was 90% in detecting the diseased glands on the correct side (right versus left). The sensitivity for RPU was 42% and the specificity was 92% (n = 26). The sensitivity of NS was 44% and the specificity was 98% (n = 52). In only one case did RPU or NS detect a gland not found by SPU. SPU can be done with accuracy comparable to other ultrasound series in the literature, and it may be superior to RPU or NS in some institutions. It is important for surgeons to be aware of local institutional expertise when relying on RPU and NS during preoperative evaluation prior to directed parathyroidectomy.
SourceAvailable from: Salvatore Minisola[Show abstract] [Hide abstract]
ABSTRACT: IntroductionOver the last 50 years, the spectrum of clinical presentation of primary hyperparathyroidism (PHPT) has shifted from a symptomatic disorder, characterized by symptoms of hypercalcemia, nephrolithiasis, and overt bone disease, toward a less symptomatic or asymptomatic disorder . The recognition of the asymptomatic variant of PHPT has markedly increased following the inclusion of serum calcium measurement in the multichannel biochemical screening.Parathyroidectomy (PTX) is the only definitive cure of PHPT. PTX is appropriate to consider in all patients with PHPT and should be recommended in patients with the symptomatic variant. The question of whether patients with asymptomatic PHPT should undergo surgery, as it is recommended in the symptomatic counterpart, has been the focus of four International Workshops. The latest has been held in Florence on September 19-21, 2013. The guidelines for surgery in patients with asymptomatic PHPT and monitoring for those who do not unde ...Journal of endocrinological investigation 03/2015; 38(5). DOI:10.1007/s40618-015-0261-3 · 1.55 Impact Factor
The Laryngoscope 02/2007; 117(2). DOI:10.1097/01.mlg.0000251591.55254.18 · 2.03 Impact Factor
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ABSTRACT: Ultrasonography of the thyroid, parathyroid, and soft tissues of the neck should always be performed before parathyroidectomy. The most cost-effective localization strategies seem to be ultrasonography followed by four-dimensional computed tomography (4DCT) or ultrasonography followed by sestamibi ± 4DCT. These localization strategies are highly dependent on the quality of imaging. Surgeons should critically evaluate the imaging and operative data at their own institution to determine the best preoperative localization strategy before parathyroidectomy. Surgeons should communicate with the referring physicians about the best localization algorithms in the local area and become the decision maker as to when to obtain them.Surgical Clinics of North America 06/2014; DOI:10.1016/j.suc.2014.02.006 · 1.93 Impact Factor