Impact of preoperative thyroid ultrasonography on the surgical management of primary hyperparathyroidism.
BACKGROUND
Primary hyperparathyroidism (PHPT) with coexisting thyroid disease has been considered a contraindication to minimally invasive parathyroidectomy (MIP). This study assessed the impact of thyroid ultrasonography and guided fine-needle aspiration (FNA) biopsy with cytological review of the aspiration in distinguishing patients eligible for MIP from those requiring open parathyroidectomy with thyroid surgery.


METHODS
The records of 194 consecutive patients who had minimally invasive or open parathyroidectomy for sporadic PHPT were reviewed retrospectively. Thyroid ultrasonographic findings and FNA results were compared with surgical and pathology records.


RESULTS
A total of 163 patients (84.0 per cent) were eligible for MIP based on ultrasonographic findings with or without FNA results. Ultrasonography detected concurrent thyroid disease in 163 patients (84.0 per cent). Thirty-nine (23.9 per cent) underwent FNA, of whom 16 had benign findings and were eligible for MIP; the remaining 23 had suspicious FNA results and had open parathyroidectomy combined with thyroid surgery. Postoperative thyroid histopathology confirmed malignancy in nine patients, eight of whom had disease detected ultrasonographically. Micronodular thyroid disease (less than 1 cm) accounted for four of nine malignancies.


CONCLUSIONS
Most patients with PHPT are eligible for MIP. Experienced ultrasonographers can diagnose coexisting micronodular and macronodular thyroid disease, and identify patients eligible for MIP.
Department of Surgical Oncology, M. D. Anderson Cancer Center, Houston, Texas 77230-1402, USA.
D P
DP
Monroe
B S
BS
Edeiken-Monroe
J E
JE
Lee
D B
DB
Evans
N D
ND
Perrier
D044963:Biopsy, Fine-Needle; D000075202:Contraindications; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016105:Parathyroidectomy; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D013965:Thyroidectomy / Q000379:methods*; D018084:Ultrasonography, Interventional