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Benefits of surgeon-performed ultrasound for primary hyperparathyroidism

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Abstract

Background

Focused, minimally invasive parathyroidectomy (MIP) is widely accepted when preoperative imaging localizes a single parathyroid adenoma. Many surgeons use 99mTc-sestamibi scintigraphy (MIBI) +/−, a cervical ultrasound for preoperative localization. We propose that surgeon-performed ultrasound (SUS) is the only imaging modality required in most patients with primary hyperparathyroidism (pHPT), resulting in patient convenience and reduced cost.

Materials and methods

Since July 2006, patients with pHPT underwent MIP based solely on a positive SUS. Intraoperative parathyroid hormone assay was used to determine the extent of operation. A retrospective review from July 2006 through December 2008 identified 160 patients who underwent parathyroidectomy after SUS on their initial office visit.

Results

SUS correctly identified an enlarged parathyroid gland in 119/160 (74%) patients. In 41 patients, SUS was the only localizing study. MIBI was done in 119 patients. In 54 patients, SUS confirmed the MIBI, and in 28 patients with a negative MIBI, SUS was positive. In the 41 patients with a negative SUS, an MIBI was positive in ten. Ninety-eight patients had MIP. Theoretically, 85 MIBIs were unnecessary because of a positive SUS corresponding to a potential cost savings of at least $90,000.

Conclusion

SUS to localize parathyroid adenomas is accurate and facilitates MIP. It provides substantial cost savings and patient convenience and should be the first diagnostic procedure performed for patients suspected to have pHPT. MIBI can be reserved for those patients in whom ultrasound has failed to localize a parathyroid gland.

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References

  1. Udelsman R (2002) Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 235:665–670 (discussion 670–662)

    Article  PubMed  Google Scholar 

  2. Ugur O, Bozkurt MF, Rubello D (2008) Nuclear medicine techniques for radio-guided surgery of hyperparathyroidism. Minerva Endocrinol 33:95–104

    PubMed  CAS  Google Scholar 

  3. Gurnell EM, Thomas SK, McFarlane I, Munday I, Balan KK, Berman L, Chatterjee VK, Wishart GC (2004) Focused parathyroid surgery with intraoperative parathyroid hormone measurement as a day-case procedure. Br J Surg 91:78–82. doi:10.1002/bjs.4463

    Article  PubMed  CAS  Google Scholar 

  4. Irvin GL 3rd et al (1996) Ambulatory parathyroidectomy for primary hyperparathyroidism. Arch Surg 131:1074–1078

    PubMed  Google Scholar 

  5. Irvin GL 3rd, Carneiro DM, Solorzano CC (2004) Progress in the operative management of sporadic primary hyperparathyroidism over 34 years. Ann Surg 239(5):704–708. doi:10.1097/01.sla.0000124448.49794.74 (discussion 708–711)

    Article  PubMed  Google Scholar 

  6. Kebebew E et al (2006) Predictors of single-gland vs multigland parathyroid disease in primary hyperparathyroidism: a simple and accurate scoring model. Arch Surg 141(8):777–782. doi:10.1001/archsurg.141.8.777 (discussion 782)

    Article  PubMed  Google Scholar 

  7. Pellitteri PK (2003) Directed parathyroid exploration: evolution and evaluation of this approach in a single-institution review of 346 patients. Laryngoscope 113:1857–1869. doi:10.1097/00005537-200311000-00003

    Article  PubMed  Google Scholar 

  8. Chen H, Sokoll LJ, Udelsman R (1999) Outpatient minimally invasive parathyroidectomy: a combination of sestamibi-SPECT localization, cervical block anesthesia, and intraoperative parathyroid hormone assay. Surgery 126:1016–1021. doi:10.1067/msy.2099.101433 (discussion 1021–1022)

    Article  PubMed  CAS  Google Scholar 

  9. Udelsman R, Donovan PI, Sokoll LJ (2000) One hundred consecutive minimally invasive parathyroid explorations. Ann Surg 232(3):331–339. doi:10.1097/00000658-200009000-00005

    Article  PubMed  CAS  Google Scholar 

  10. Udelsman R (2002) Surgery in primary hyperparathyroidism: the patient without previous neck surgery. J Bone Miner Res 17:126–132

    Google Scholar 

  11. Haber RS, Kim CK, Inabnet WB (2002) Ultrasonography for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism: comparison with (99m) technetium sestamibi scintigraphy. Clin Endocrinol (Oxf) 57:241–249

    Article  Google Scholar 

  12. Tublin ME et al (2009) Localization of parathyroid adenomas by sonography and technetium Tc 99m sestamibi single-photon emission computed tomography before minimally invasive parathyroidectomy: are both studies really needed? J Ultrasound Med 28(2):183–905

    PubMed  Google Scholar 

  13. Solorzano CC et al (2005) Surgeon-performed ultrasound improves localization of abnormal parathyroid glands. Am Surg 71:557–562 (discussion 562–563)

    PubMed  Google Scholar 

  14. Quiros RM, Alioto J, Wilhelm SM, Ali A, Prinz RA (2004) An algorithm to maximize use of minimally invasive parathyroidectomy. Arch Surg 139:501–506. doi:10.1001/archsurg.139.5.501 (discussion 506–507)

    Article  PubMed  Google Scholar 

  15. Abboud B, Sleilaty G, Rabaa L, Daher R, Abou Zeid H, Jabbour H, Hachem K, Smayra T (2008) Ultrasonography: highly accuracy technique for preoperative localization of parathyroid adenoma. Laryngoscope 118:1574–1578. doi:10.1097/MLG.0b013e31817aecad

    Article  PubMed  Google Scholar 

  16. Solorzano CC, Carneiro-Pla DM, Irvin GL 3 rd (2006) Surgeon-performed ultrasonography as the initial and only localizing study in sporadic primary hyperparathyroidism. J Am Coll Surg 202:18–24. doi:10.1016/j.jamcollsurg.2005.08.014

    Article  PubMed  Google Scholar 

  17. Soon PS, Delbridge LW, Sywak MS, Barraclough BM, Edhouse P, Sidhu SB (2008) Surgeon performed ultrasound facilitates minimally invasive parathyroidectomy by the focused lateral mini-incision approach. World J Surg 32:766–771. doi:10.1007/s00268-007-9436-1

    Article  PubMed  Google Scholar 

  18. Milas M, Stephen A, Berber E, Wagner K, Miskulin J, Siperstein A (2005) Ultrasonography for the endocrine surgeon a valuable clinical tool that enhances diagnostic and therapeutic outcomes. Surgery 138:1193–1200. doi:10.1016/j.surg.2005.08.032 (discussion 1200–1191)

    Article  PubMed  Google Scholar 

  19. Milas M, Mensah A, Alghoul M, Berber E, Stephen A, Siperstein A, Weber CJ (2005) The impact of office neck ultrasonography on reducing unnecessary thyroid surgery in patients undergoing parathyroidectomy. Thyroid 15:1055–1059. doi:10.1089/thy.2005.15.1055

    Article  PubMed  Google Scholar 

  20. Carling T, Udelsman R (2008) Focused approach to parathyroidectomy. World J Surg 32:1512–1517. doi:10.1007/s00268-008-9567-z

    Article  PubMed  Google Scholar 

  21. Siperstein A, Berber E, Barbosa GF, Tsinberg M, Greene AB, Mitchell J, Milas M (2008) Predicting the success of limited exploration for primary hyperparathyroidism using ultrasound, sestamibi, and intraoperative parathyroid hormone: analysis of 1158 cases. Ann Surg 248:420–428

    PubMed  Google Scholar 

  22. Arici C, Cheah WK, Ituarte PH, Morita E, Lynch TC, Siperstein AE, Duh QY, Clark OH (2001) Can localization studies be used to direct focused parathyroid operations? Surgery 129:720–729. doi:10.1067/msy.2001.114556

    Article  PubMed  CAS  Google Scholar 

  23. Chapuis Y, Fulla Y, Bonnichon P, Tarla E, Abboud B, Pitre J, Richard B (1996) Values of ultrasonography, sestamibi scintigraphy, and intraoperative measurement of 1–84 PTH for unilateral neck exploration of primary hyperparathyroidism. World J Surg 20:835–839. doi:10.1007/s002689900127 (discussion 839–840)

    Article  PubMed  CAS  Google Scholar 

  24. Lumachi F, Zucchetta P, Marzola MC, Boccagni P, Angelini F, Bui F, D’Amico DF, Favia G (2000) Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism. Eur J Endocrinol 143:755–760. doi:10.1530/eje.0.1430755

    Article  PubMed  CAS  Google Scholar 

  25. Freudenberg LS, Frilling A, Sheu SY, Gorges R (2006) Optimizing preoperative imaging in primary hyperparathyroidism. Langenbecks Arch Surg 391:551–556. doi:10.1007/s00423-006-0076-y

    Article  PubMed  Google Scholar 

  26. Erbil Y, Barbaros U, Yanik BT, Salmaslioglu A, Tunaci M, Adalet I, Bozbora A, Ozarmagan S (2006) Impact of gland morphology and concomitant thyroid nodules on preoperative localization of parathyroid adenomas. Laryngoscope 116:580–585. doi:10.1097/01.MLG.0000203411.53666.AD

    Article  PubMed  Google Scholar 

  27. Berber E, Parikh RT, Ballem N, Garner CN, Milas M, Siperstein AE (2008) Factors contributing to negative parathyroid localization: an analysis of 1000 patients. Surgery 144:74–79. doi:10.1016/j.surg.2008.03.019

    Article  PubMed  Google Scholar 

  28. Davis ML, Quayle FJ, Middleton WD, Acosta LM, Hix-Hernandez SJ, Snyder SK, Moley JF, Brunt LM, Lairmore TC (2007) Ultrasound facilitates minimally invasive parathyroidectomy in patients lacking definitive localization from preoperative sestamibi scan. Am J Surg 194:785–790. doi:10.1016/j.amjsurg.2007.07.020 (discussion 790–781)

    Article  PubMed  Google Scholar 

  29. Haciyanli M, Lal G, Morita E, Duh QY, Kebebew E, Clark OH (2003) Accuracy of preoperative localization studies and intraoperative parathyroid hormone assay in patients with primary hyperparathyroidism and double adenoma. J Am Coll Surg 197:739–746. doi:10.1016/S1072-7515(03)00676-8

    Article  PubMed  Google Scholar 

  30. Lombardi CP, Raffaelli M, Traini E, Di Stasio E, Carrozza C, De Crea C, Zuppi C, Bellantone R (2008) Intraoperative PTH monitoring during parathyroidectomy: the need for stricter criteria to detect multiglandular disease. Langenbecks Arch Surg 393:639–645. doi:10.1007/s00423-008-0384-5

    Article  PubMed  Google Scholar 

  31. Weber KJ, Misra S, Lee JK, Wilhelm SW, DeCresce R, Prinz RA (2004) Intraoperative PTH monitoring in parathyroid hyperplasia requires stricter criteria for success. Surgery 136:1154–1159. doi:10.1016/j.surg.2004.05.060

    Article  PubMed  Google Scholar 

  32. Ghaheri BA, Koslin DB, Wood AH, Cohen JI (2004) Preoperative ultrasound is worthwhile for reoperative parathyroid surgery. Laryngoscope 114:2168–2171. doi:10.1097/01.mlg.0000149451.45264.90

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612-3833, USA

    Shalini Arora, Paul R. Balash, Jenny Yoo, Gardner S. Smith & Richard A. Prinz

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  1. Shalini Arora
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  2. Paul R. Balash
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  3. Jenny Yoo
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  4. Gardner S. Smith
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  5. Richard A. Prinz
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Correspondence to Richard A. Prinz.

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Best of endocrine surgery in Europe 2009.

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Arora, S., Balash, P.R., Yoo, J. et al. Benefits of surgeon-performed ultrasound for primary hyperparathyroidism. Langenbecks Arch Surg 394, 861–867 (2009). https://doi.org/10.1007/s00423-009-0522-8

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