Surgeon-performed ultrasound for primary hyperparathyroidism

• Published in: The American surgeon Vol. 79; no. 7; pp. 681 - 685
• Main Authors: Schenk, 3rd, Worthington G, Hanks, John B, Smith, Philip W
• Format: Journal Article
• Language: English
• Published: United States SAGE PUBLICATIONS, INC 01.07.2013
• Subjects: Accuracy; Adenoma - diagnostic imaging; Adenoma - surgery; Adult; Female; Humans; Hyperparathyroidism, Primary - diagnostic imaging; Hyperparathyroidism, Primary - surgery; Male; Medical imaging; NMR; Nuclear magnetic resonance; Parathyroid Neoplasms - diagnostic imaging; Parathyroid Neoplasms - surgery; Patient satisfaction; Patients; Studies; Surgery; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonic imaging; Ultrasonography
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313481307900711

The role of preoperative parathyroid imaging continues to evolve. This study evaluated whether surgeon-performed ultrasound (U/S) obviates the need for other imaging studies and leads to a focused exploration with a high degree of surgical success. From July 2010 to February 2012, 200 patients presenting with nonfamilial primary hyperparathyroidism underwent neck U/S in the surgeon's office. The U/S interpretation was classified as Class 1 if an adenoma was identified with high confidence, Class 2 if a possible but not definite enlarged gland was imaged, and Class 0 (zero) if no adenoma was identified. The findings were correlated with subsequent intraoperative findings. There were 144 Class 1 U/Ss (72%); of 132 patients coming to surgery, 96.2 per cent had surgical findings concordant with preoperative U/S and all had apparent surgical cure. Twenty-nine patients (14.5%) had Class 2 U/S; the 31 per cent confirmed false-positives in this group were usually colloid nodules. Fourteen of 27 with Class 0 U/S underwent surgery after being offered dynamically enhanced computed tomography scan. All 200 patients were apparent surgical cures. Surgeon-performed U/S is expedient, convenient, inexpensive, and accurate. A clearly identified adenoma can safely lead to a focused limited exploration and avoid additional imaging 93 per cent of the time.