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Diagnostic value of endoscopic ultrasonography for preoperative localization of parathyroid adenomas

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Abstract

The most common cause of primary hyperparathyroidism (PHPT) is a single, sporadic parathyroid adenoma. Ultrasonography (US) and 99mTechnetium methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy are the imaging methods most widely used to localize parathyroid adenomas. The purpose of the present study was to determine the diagnostic value and accuracy of endoscopic ultrasonography (EUS) for localizing parathyroid adenoma compared with those of US and 99mTc-MIBI scintigraphy. Forty-seven patients with a PHPT diagnosis and who were recommended for surgery were enrolled in this study. An endoscopist who was blinded to the previous US and 99mTc-MIBI scintigraphy results performed the EUS in each patient. Thirty-nine female and eight male patients with PHPT were evaluated. The presence of adenoma was confirmed by subsequent postsurgical pathology results. One case was excluded because the histopathological evaluation was compatible with a lymph node, although the lesion was detected using three different imaging modalities preoperatively. The locations of the parathyroid adenomas were correctly documented by US in 39 patients (84.7 %) by 99mTc-MIBI scintigraphy in 35 (76.0 %), and by EUS in 44 (95.6 %) of 46 patients. EUS located all 31 adenomas detected previously with US and 99mTc-MIBI scintigraphy. EUS also successfully located three adenomas that could not be identified by US and 99mTc-MIBI scintigraphy. The positive predictive value and diagnostic accuracy of EUS, US, and 99mTc-MIBI were 97.7, 97.7, and 95.6 %; 88.6, 97.5, and 86.9 %; and 77.7, 97.2, 76.0 %, respectively. EUS was preferred as the second step imaging tool for detecting parathyroid adenomas that could not be localized by US and 99mTc-MIBI scintigraphy.

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Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, No: 2, Bilkent Yolu, Ankara, Turkey

    Reyhan Ersoy, Berna Evranos Ogmen, Sefika Burcak Polat & Bekir Cakir

  2. Department of Gastroenterology Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey

    Osman Ersoy

  3. Department of General Surgery, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey

    Mehmet Kilic

  4. Department of Nuclear Medicine, Ankara Ataturk Research and Training Hospital, Ministry of Health, Ankara, Turkey

    Nilufer Yildirim

  5. Department of Anesthesiology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey

    Levent Ozturk

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  1. Reyhan Ersoy
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Correspondence to Reyhan Ersoy.

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Ersoy, R., Ersoy, O., Evranos Ogmen, B. et al. Diagnostic value of endoscopic ultrasonography for preoperative localization of parathyroid adenomas. Endocrine 47, 221–226 (2014). https://doi.org/10.1007/s12020-013-0152-3

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  • DOI: https://doi.org/10.1007/s12020-013-0152-3

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