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

Aspinall,; Nicholson, S; Rd, Bliss; Tw, Lennard

doi:10.1308/003588412x13171221498389

Cited by 15 publications

(16 citation statements)

References 23 publications

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“…In a UK-based study, Aspinall et al. 15 found that surgeon-performed ultrasound had an accuracy of 86% in detecting the position of parathyroid adenomas in outpatient clinics. It should be borne in mind that apart from its value in localising primary parathyroid adenomas, 99m Tc-sestamibi-SPECT/CT is vital for identifying major parathyroid ectopias 16 and parathyroid glands in secondary hyperparathyroidism.…”

Section: Discussionmentioning

confidence: 99%

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

Thomas

Beggs

Han

2019

JRSM Cardiovascular Disease

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Background Primary hyperparathyroidism arising from parathyroid adenoma is one of the most common endocrine disorders treated by endocrine surgeons. The adenoma is commonly identified by imaging techniques. The present study evaluated the performance of a portable ultrasound machine (Sonosite MicroMaxx) operated by a surgeon, departmental ultrasound and 99m Tc-sestamibi-SPECT/CT by a radiologist in the identification of parathyroid adenomas. Methods Patient case notes were retrieved from medical records and imaging from picture archiving and communication system over the period from 2006 to 2012. 99m Tc-sestamibi-SPECT/CT and departmental ultrasound images were reported by a nuclear radiologist. The ability of each imaging technique in localising parathyroid adenomas was referenced against the actual adenomas identified from parathyroidectomy. Results With reference to the actual site of the lesion, surgeon-performed ultrasound accurately localised the site of the lesion in 30/33 (90.1%) of cases with a sensitivity of 86.7%, departmental ultrasound accurately localised the site of the lesion in 21/26 (80.1%) of cases with a sensitivity of 79.2%. In 6/75 patients where 99m Tc-sestamibi-SPECT/CT did not localise the lesion, departmental ultrasound did not localise any lesions correctly, while surgeon-performed ultrasound successfully located the adenoma in three (50%) of these six patients. Patients whose parathyroid adenomas identified by the surgeon were more likely to have shorter length of stay in hospital: odds ratio = 0.53 (95% confidence interval = 0.30–0.92, p = 0.025). Conclusions Surgeon-performed ultrasound for immediately pre-operative localisation improves identification of parathyroid adenomas and reduces length of stay in hospital, lending support for the use of this technique by endocrine surgeons.

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Section: Discussionmentioning

confidence: 99%

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

Thomas

Beggs

Han

2019

JRSM Cardiovascular Disease

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“…16 Recent interest in the merits of surgeon performed parathyroid ultrasonography has been evident. 17 It has been described in various studies as an appropriate method of parathyroid location and its accuracy has been compared with sestamibi imaging. [18][19][20] Apart from the low cost and non-invasiveness, it has been shown to provide accurate anatomic delineation of the adenomas relative to the thyroid gland, carotid artery and the clavicles, thereby facilitating a limited dissection.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography alone can reliably locate parathyroid tumours and facilitates minimally invasive parathyroidectomy

Butt

Husainy

Bolia

et al. 2015

annals

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INTRODUCTION Minimally invasive parathyroidectomy (MIP) is performed via a short incision (≤3cm). Previous studies have employed multiple imaging modalities including ultrasonography, sestamibi imaging and/or intraoperative parathyroid hormone assay. We present our eight-year experience of MIP using ultrasonography alone. METHODS One hundred parathyroidectomies performed by a single surgeon between April 2004 and December 2012 were identified in a prospectively maintained database. All patients underwent ultrasonography including preoperative marking of the lesion by a single radiologist. No other localising diagnostic tests were performed. RESULTS Of the 100 patients (69% female) who underwent parathyroidectomy, 93 had MIP. The median age of all cases was 58 years (range: 19-90 years). All patients exhibited an elevated parathyroid hormone level (median: 19pmol) in the presence of hypercalcaemia (median: 2.86mmol/l, range: 2.54-3.94mmol/l). Conventional surgery was indicated in seven patients owing to the need for concurrent thyroidectomy. The median operative time was 30 minutes (range: 10-130 minutes). Ultrasonography localised parathyroid tumour position correctly in 98% of patients who underwent MIP, and in 97% across both MIP and non-MIP groups. Postoperative complications requiring treatment included pancreatitis and symptomatic hypocalcaemia. Follow-up review at 6-8 weeks demonstrated that 86% of open cases (6/7) and 94% of MIP cases (87/93) were rendered normocalcaemic. CONCLUSIONS Our study is the first to demonstrate that the sole use of ultrasonography including preoperative marking can localise parathyroid tumours correctly in 98% of cases suitable for MIP.

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“…9 The most recent studies demonstrate US as a single imaging modality to be equivalent or even more accurate than sestamibi, specifically when performed by a fellowship-trained radiologist or the surgeon. [10][11][12] In our study, US localized disease in nearly 75% of patients with an accuracy of 82%. These results are comparable to those obtained in other studies.…”

Section: Discussionmentioning

confidence: 54%

Ultrasound for Localization in Primary Hyperparathyroidism

Smith

Evasovich

Girod

et al. 2013

Otolaryngol.--head neck surg.

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Objective To evaluate the capability of ultrasound for preoperative localization in primary hyperparathyroidism. Study Design Prospective study. Setting Multi-institutional Midwest Head and Neck Cancer Consortium. Subjects and Methods Two hundred twenty patients who underwent preoperative localization and had parathyroid surgery were evaluated. The findings of preoperative localization studies were correlated with surgical findings. Results Preoperative ultrasonography, sestamibi scintigraphy, or both were obtained in 77%, 93%, and 69% of the patients, respectively. Preoperative ultrasonography and sestamibi scintigraphy localized an abnormality in 71% and 79% of patients, respectively. At the time of surgery, the localization by ultrasound was accurate in 82%. The accuracy of localization was similar for sestamibi scintigraphy (85%). In patients with inaccurate ultrasound localization, the sestamibi scintigraphy correctly identified the site of disease in only 45%. In patients with a nonlocalizing ultrasound, sestamibi scintigraphy was able to localize disease in only 47%, with 2 being in the mediastinum. Conclusions Ultrasonography is an acceptable initial localization study for patients with primary hyperparathyroidism. In patients with nonlocalizing ultrasound, sestamibi scintigraphy should be obtained, but can be expected to detect an abnormality in less than 50% of patients.

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

Cited by 15 publications

References 23 publications

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

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

Ultrasonography alone can reliably locate parathyroid tumours and facilitates minimally invasive parathyroidectomy

Ultrasound for Localization in Primary Hyperparathyroidism

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