Benefits of surgeon-performed ultrasound for primary hyperparathyroidism.
BACKGROUND
Focused, minimally invasive parathyroidectomy (MIP) is widely accepted when preoperative imaging localizes a single parathyroid adenoma. Many surgeons use (99m)Tc-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.


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.


CONCLUSIONS
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.
Arora
Shalini
S
Department of General Surgery, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612-3833, USA.
Balash
Paul R
PR
Yoo
Jenny
J
Smith
Gardner S
GS
Prinz
Richard A
RA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010280:Parathyroid Glands / Q000000981:diagnostic imaging*; D016105:Parathyroidectomy; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012086:Reoperation; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D014463:Ultrasonography; D055815:Young Adult
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi