EndocrineAn analysis of whether surgeon-performed neck ultrasound can be used as the main localizing study in primary hyperparathyroidism
Section snippets
Methods
Between 2000 and 2009, 1,000 consecutive patients underwent first-time parathyroid surgery (PTX) for sporadic PHP in the Department of Endocrine Surgery at the Cleveland Clinic. The data were collected in a prospectively maintained database approved by the Institutional Review Board.
All patients underwent preoperative imaging with surgeon-performed neck US at the time of their initial clinic visit (Aloka 5600 US machine with 7.5 MHz curved fingerprint transducer; Aloka, Wallingford, CT). An
Results
There were 774 (77%) female and 226 (23%) male patients with a mean age of 60.0 ± 1.0 years. The exploration findings were 72% (n = 717) single adenoma, 16% (n = 155) double adenoma, and 13% (n = 128) hyperplasia. When US suggested single-gland disease in 84% (n = 842) of patients, MIBI was concordant with US in 82.5%, discordant and false in 8%, negative in 7%, and discordant but correct in 2.5% (Fig 1). When US suggested multigland disease in 7% (n = 68) of patients, MIBI was concordant with
Discussion
This study shows that MIBI provides additional useful information in only a minority of patients with a positive US in PHP. Nevertheless, MIBI benefited approximately half of patients with a negative US. Because one-third of this patient population had unrecognized thyroid nodules as well, our results suggest that the most cost-effective algorithm for localization in PHP would be to do US first and reserve MIBI for US-negative cases.
According to our results, when US showed single-gland disease,
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