Benefits of surgeon-performed ultrasound for primary hyperparathyroidism

Arora, Shalini; Balash, Paul R.; Yoo, Jenny; Smith, G.; Prinz, Richard A.

doi:10.1007/s00423-009-0522-8

Cited by 43 publications

(30 citation statements)

References 30 publications

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“…4,5 The outcomes of surgeon-based ultrasonography (SUS) in parathyroid disease have been reported from North America and Australasia though not from the UK. [6][7][8][9][10][11][12][13][14][15] The sensitivity of SUS of 60-89% reported in these studies is equivalent or superior to radiology-based ultrasonography (RUS) and SUS has now become a useful adjunct to parathyroid surgery in these countries.…”

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confidence: 97%

The impact of surgeon-based ultrasonography for parathyroid disease on a British endocrine surgical practice

Aspinall

Nicholson

et al. 2012

annals

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INTRODUCTION Surgeon-based ultrasonography (SUS) for parathyroid disease has not been widely adopted by British endocrine surgeons despite reports worldwide of accuracy in parathyroid localisation equivalent or superior to radiology-based ultrasonography (RUS). The aim of this study was to determine whether SUS might benefit parathyroid surgical practice in a British endocrine unit. METHODS Following an audit to establish the accuracy of RUS and technetium sestamibi (MIBI) in 54 patients, the accuracy of parathyroid localisation by SUS and RUS was compared prospectively with operative findings in 65 patients undergoing surgery for primary hyperparathyroidism (pHPT). RESULTS The sensitivity of RUS (40%) was below and MIBI (57%) was within the range of published results in the audit phase. The sensitivity (64%), negative predictive value (86%) and accuracy (86%) of SUS were significantly greater than RUS (37%, 77% and 78% respectively). SUS significantly increased the concordance of parathyroid localisation with MIBI (58% versus 32% with RUS). CONCLUSIONS SUS improves parathyroid localisation in a British endocrine surgical practice. It is a useful adjunct to parathyroid practice, particularly in centres without a dedicated parathyroid radiologist, and enables more patients with pHPT to benefit from minimally invasive surgery.

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confidence: 97%

The impact of surgeon-based ultrasonography for parathyroid disease on a British endocrine surgical practice

Aspinall

Nicholson

et al. 2012

annals

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“…There is a learning curve associated with SUS. Arora et al [48] mentioned that they confirmed their SUS with MIBI for the first 250 patients, to complete the learning curve. In our method we think that only ten cases are enough for a learning curve, because we perform US in the presence of a radiologist, not a surgeon alone.…”

Section: Discussionmentioning

confidence: 97%

Improvement of minimally invasive parathyroidectomy outcomes by real time ultrasonography performed by a surgeon and radiologist team.

et al. 2015

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Aims: Minimally invasive parathyroidectomy (MIP) has become the first line of treatment for primary hyperparathyroidism caused by solitary parathyroid adenoma. In order to increase the sensitivity of high-resolution ultrasonography (hUS), surgeon performed ultrasonography (SUS) has been increasingly used preoperatively. However, a radiologist and surgeon performing ultrasonography (RSUS) has not been a usual practice. In this study, we aimed to evaluate the clinical contribution of RSUS on MIP. Material and methods: From 2012 to 2014, a total of 30 consecutive patients (4 male, 26 female, mean age 48.87±14.52 years) with solitary parathyroid adenoma, were included in the study. All patients underwent preoperative hUS and Technetium-99m sestamibi scintigraphy. In patients, demographic characteristics, diagnostic tools used, levels of biochemical parameters, duration of operation, and length of hospital stay were recorded. Results: Adenomas were successfully localized by US in all patients and the surgical approach was determined according to this localization. Parathyroidectomy with MIP was successfully performed under local anesthesia in all patients. Mean operation time was 19.87±3.35 min. Postoperative PTH and calcium values were significantly decreased. All patients were discharged from the hospital in the same day. None of the patients had complications such as recurrent laryngeal nerve injury, hematoma, or injury to nearby organs. None of the patients had drains placed. Conclusions: Adenoma is well localized by US and thus, MIP can be completed under local anesthesia. US provides a very important clinical contribution to the success of MIP. In addition to these, RSUS helps in determining the location of the incision and the shortest way to achieve the lesion; therefore, it provides a small incision and shortens duration of the operation with a minimal dissection.

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“…The detection of concomitant thyroid nodules that may need fine needle aspiration biopsy may help to prepare the patient and surgeon to deal with this pathology. Ultrasound is also more cost-effective than sestamibi scanning [9] . Sestamibi remains a valuable resource in the diagnosis of primary hyperparathyroidism, but should be reserved for cases where ultrasound gives equivocal results.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound is a rapid technique for surveying the anterior compartment of the neck, but questions remain regarding the operator's effect on resultant sensitivity [9,10] . Therefore, the goals of this study were to independently evaluate both neck ultrasonography and sestamibi as single-modality screening tools for the localization of hyperactive parathyroid glands in primary hyperparathyroidism, and to evaluate the effects of cervical ultrasonography operator variability on subsequent findings.…”

Section: Introductionmentioning

confidence: 99%

Can Ultrasound Be Used as the Primary Screening Modality for the Localization of Parathyroid Disease prior to Surgery for Primary Hyperparathyroidism? A Review of 440 Cases

Levy¹,

Kandil²,

Yau

et al. 2011

ORL

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Background/Aims: Sestamibi scintigraphy and neck ultrasonography have both been proposed as screening modalities for the detection of abnormal parathyroid glands in patients with primary hyperparathyroidism. As a result, many surgeons use both techniques prior to surgery. The goal of this study was to independently evaluate both ultrasound and sestamibi as single-modality preoperative screening tools for primary hyperparathyroidism. Methods: A retrospective review of consecutive patients who underwent surgery for primary hyperparathyroidism from January 1999 to December 2009. Imaging results were compared to surgical findings. Results: 440 patients were found to meet inclusion criteria. Sensitivities for correct localization of a single parathyroid adenoma for sestamibi versus ultrasound were: 83% (95% CI 78–86) versus 72% (95% CI 67–76). Ultrasound operator had no influence on sensitivity, and ultrasound identified nodular thyroid disease in 31% of patients. Conclusion: Ultrasonography alone can be used as the primary screening modality in patients with primary hyperparathyroidism. Ultrasound sensitivity is conserved despite operator variability, and identifies concomitant thyroid pathology.

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Benefits of surgeon-performed ultrasound for primary hyperparathyroidism

Cited by 43 publications

References 30 publications

The impact of surgeon-based ultrasonography for parathyroid disease on a British endocrine surgical practice

The impact of surgeon-based ultrasonography for parathyroid disease on a British endocrine surgical practice

Improvement of minimally invasive parathyroidectomy outcomes by real time ultrasonography performed by a surgeon and radiologist team.

Can Ultrasound Be Used as the Primary Screening Modality for the Localization of Parathyroid Disease prior to Surgery for Primary Hyperparathyroidism? A Review of 440 Cases

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