Surgeon-Performed Ultrasound as Preoperative Localization Study in Patients with Primary Hyperparathyroidism

Abstract

Background: Minimally invasive parathyroidectomy is the treatment of choice for single-gland primary hyperparathyroidism. However, the exact location of the abnormal gland has to be established. Sestamibi scintigraphy, computed tomography and ultrasound (US) are commonly used modalities. We describe our experience in a non-academic center with surgeon-performed US (S-US) of the neck as preoperative localization study in patients with primary hyperparathyroidism (PHPT). Methods: Patients with a biochemically proven diagnosis of PHPT and preoperative S-US were included. Data were recorded prospectively. Perioperative gland location was compared to the preoperative S-US to determine sensitivity, specificity and accuracy rates. Results: Two of the 50 patients who underwent S-US were not subjected to surgery. In 85% of the patients analyzed by S-US, the appropriate abnormal gland(s) were identified. In 11%, no gland was identified, but abnormal glands were found during surgery. Sensitivity of S-US in our hospital is 85%, with a positive predictive value of 97%. Conclusions: We achieved a satisfactory sensitivity rate. S-US provides anatomic information to the surgeon which enables a more detailed operation planning, and it is a valuable diagnostic modality for patients with PHPT in our opinion. We hope that our data encourage other centers to implement this technique as well.

Utility of surgeon-performed pre-operative ultrasound in the localisation of parathyroid adenomas

“…Other studies have found similar results including those by van Ginhoven et al. 12 with reported accuracy of 85%. Solorzano et al.…”

Otolaryngologist-performed head and neck ultrasound: outcomes and challenges in learning the technique

“…[6][7][8] Other studies focused on the advantage of clinic-based ultrasound in changing decisions about operative management of thyroid disease when compared to scans performed by a conventional ultrasound practitioner before the clinic visit. 9 Spurious lesions are frequent in head and neck ultrasound (Table III), commonly the result The process of palpation before the scan does not necessarily facilitate the ultrasound study.…”

Surgery in Primary Hyperparathyroidism: Extensive Personal Experience

“…The main drawback of US is related to its operator dependence resulting in highly variable localization. Some studies suggest improved sensitivity of parathyroid tumor localization with surgeon-performed US (rather than technician-or radiologist-performed US) (32,33). Other studies report improved sensitivity of parathyroid tumor localization when US was used in combination with sestamibi-SPECT (27).…”