Ultrasound for Localization in Primary Hyperparathyroidism

Smith, Russell B.; Evasovich, Maria; Girod, Douglas A.; Jorgensen, Jeffrey B.; Lydiatt, William M.; Pagedar, Nitin A.; Spanos, Willam C.

doi:10.1177/0194599813491063

Cited by 25 publications

(15 citation statements)

References 16 publications

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“…US represents an abnormal parathyroid gland as an oval, bean-shaped, or infrequently, multilobulated hypoechoic mass with a well-defined margin, located posteriorly or inferiorly to the thyroid gland ( Fig. 1 ) [ 27 - 29 ]. Parathyroid lesions are usually very vascular, typically showing a peripheral vascular arc and a prominent polar feeding vessel that arises from the branches of the inferior thyroidal artery ( Fig.…”

Section: Localization Of Hyperfunctioning Parathyroid Lesionsmentioning

confidence: 99%

“…The reported sensitivities of SS and US in the detection of single parathyroid adenomas are comparable, with a range of 68%-95% for SS and a range of 72%-89% for US. However these techniques have substantially lower sensitivities in the detection of multiglandular disease [ 1 , 24 , 27 - 29 ]. As expected, a preoperative approach that combines both SS and US is more accurate than either technique alone.…”

Section: Localization Of Hyperfunctioning Parathyroid Lesionsmentioning

confidence: 99%

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Parathyroid ultrasonography: the evolving role of the radiologist

Sung

2015

Ultrasonography

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Previously, radiologists played a limited role in the treatment of parathyroid disease, primary focusing on the preoperative localization of parathyroid lesions responsible for hyperparathyroidism. But, the widespread use of high-resolution ultrasound has lead to the increasing detection of parathyroid incidentalomas (PTIs). Consequently, radiologists may be required to differentiate PTIs from thyroid lesions, which is most reliably accomplished through the fine needle aspiration-parathyroid hormone analysis. Various nonsurgical treatment modalities for hyperfunctioning parathyroid lesions have been developed with some efficacy. Especially for symptomatic nonfunctioning parathyroid cysts, simple aspiration is a first-line procedure for diagnosis and treatment, while ethanol ablation is a subsequent treatment modality for recurrent cases.

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Section: Localization Of Hyperfunctioning Parathyroid Lesionsmentioning

confidence: 99%

Section: Localization Of Hyperfunctioning Parathyroid Lesionsmentioning

confidence: 99%

Parathyroid ultrasonography: the evolving role of the radiologist

Sung

2015

Ultrasonography

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“…Ultrasonography (US) and radionuclide ( 99m Tc-sestamibi) imaging are the most widely used tools for detecting parathyroid abnormalities in patients with PHPT (6,7). Although US plays a major role in the pre-surgical localization of parathyroid masses, US has shown low specificity for differentiating PTC from its benign entities, such as adenoma or hyperplasia (7,9,10).…”

Section: Introductionmentioning

confidence: 99%

Differentiation of parathyroid carcinoma and adenoma by preoperative ultrasonography

2016

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Background Parathyroid carcinomas (PTC) are very rare. There have been a few studies on the contribution of ultrasound (US) in the diagnosis of PTC compared with parathyroid adenomas (PTA). Purpose To identify the differences between US findings of PTC and PTA in patients with primary hyperparathyroidism (PHPT). Material and Methods We enrolled seven patients with PTC and 32 consecutive patients with PTA whose diagnoses were confirmed by surgery at our institution between March 1994 and June 2015. We retrospectively compared the US features of the two groups, as well as the demographic, clinical, and biochemical characteristics (age, gender, palpability, and serum ionized calcium and parathyroid hormone [PTH] levels). Results The patients with PTC and PTA did not exhibit significant differences in terms of mean age (59.0 years versus 51.1 years; P = 0.2063), sex distribution (male:female, 4:3 versus 1:3; P = 0.1716), mean PTH levels (2855.0 pg/mL versus 1821.5 pg/mL; P = 0.2067), and mean ionized calcium levels (1.7 mMol/L versus 1.5 mMol/L; P = 0.1585) except palpability ( P < 0.0001). On US images, the PTCs were significantly larger (3.5 cm versus 1.9 cm; P = 0.0133) and exhibited higher incidences of heterogeneous echotexture ( P = 0.0002), irregular shape ( P < 0.0001), non-circumscribed margin ( P < 0.0001), intra-nodular calcifications ( P = 0.014), and local invasion ( P = 0.0004) compared to the PTAs. Conclusion In preoperative patients with PHPT, PTCs are differentiated from PTAs by their palpability and significant US features: large size, heterogeneous echotexture, irregular shape, non-circumscribed margin, intra-nodular calcifications, and local invasion.

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“…In experienced hands, sonography-guided FNA is a safe and accurate procedure. [43][44][45] In conclusion, this study shows that ITMs can present as a discrete nodule, either solitary or part of a multinodular thyroid, or as diffuse infiltrative disease with features overlapping those of benign and malignant thyroid disease regardless of the site of the primary tumor. In patients with a previous or current extrathyroid malignancy, thyroid nodules or diffuse infiltration of the thyroid on sonography should be viewed as a potential intrathyroid metastasis and evaluated by using sonography-guided FNA.…”

Section: Discussionmentioning

confidence: 59%

Sonographic Evaluation of Intrathyroid Metastases

et al. 2016

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Objectives-Intrathyroid metastases from extrathyroid primary tumors are rare. Clinical findings may be subtle, but detection of intrathyroid metastases has improved with sonography. The objective of this study was to evaluate the sonographic appearance of intrathyroid metastases.Methods-Patients with thyroid masses with cytopathologic features matching those of an extrathyroid primary tumor were retrospectively identified. The appearances of intrathyroid metastases on sonography were reviewed for the following features: size, margin regularity, echogenicity, echotexture, vascularity on power or color Doppler ultrasonography, and the presence or absence of any associated cervical adenopathy.Results-The study included 52 patients. The most frequent primary tumor sites were lung, head and neck, and breast. Intrathyroid metastases presented as a discrete nodule in 34 patients and as diffuse infiltration of the gland in 18 patients. The discrete nodules ranged in size from 1.1 to 5.6 cm (mean 6 SD, 2.5 6 1.2 cm). Thirtythree lesions (63%) had irregular margins, and 19 (37%) had well-defined margins. Most of the lesions were heterogeneously hypoechoic (n 5 50, 96%). Vascularity was present in 32 of 50 measured lesions (64%) that were evaluated with Doppler sonography. Cervical adenopathy was present in 37 patients (71%).Conclusions-Intrathyroid metastases have sonographic characteristics similar to those described for both benign and malignant thyroid diseases. In patients with a previous or current extrathyroid malignancy, thyroid nodules or diffuse infiltration of the thyroid gland on sonography should be viewed as a potential intrathyroid metastasis and evaluated via ultrasound-guided fine-needle aspiration regardless of the site of the primary tumor.

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Ultrasound for Localization in Primary Hyperparathyroidism

Cited by 25 publications

References 16 publications

Parathyroid ultrasonography: the evolving role of the radiologist

Parathyroid ultrasonography: the evolving role of the radiologist

Differentiation of parathyroid carcinoma and adenoma by preoperative ultrasonography

Sonographic Evaluation of Intrathyroid Metastases

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