Surgeon-performed ultrasound: a single institution experience in parathyroid localization.

Jabiev AA, Lew JI, Solorzano CC
Surgery. 2009 146 (4): 569-75; discussion 575-7

PMID: 19789014 · DOI:10.1016/j.surg.2009.06.043

BACKGROUND - Ultrasound has been used successfully to localize parathyroid glands. This study evaluates surgeon-performed ultrasound (SUS) for pre-operative parathyroid localization prior to parathyroidectomy.

METHODS - In all, 442 patients with primary hyperparathyroidism (HPT) underwent SUS at a single institution. Patients were divided into 2 groups: group 1 (n = 338) had correct localization, and group 2 (n = 104) had incorrect localization. The true-positive (TP) rate and peri-operative findings were compared. TP was defined as localization of all abnormal parathyroids resulting in operative success. A P value >.05 was considered significant.

RESULTS - Of 442 patients, 338 (76.5%) had TP results. Group 1 patients were younger (57 vs 63 years; P < .0001) with larger gland size: 2.1 versus 1.8 cm (P = .08). In group 2, 45/104 (43%) patients had false-positive SUS, and 59/104 (57%) had negative studies or missed multiglandular disease (MGD). Group 1 patients had shorter operative times (60 vs 80 min, P = .002), fewer bilateral neck explorations (BNEs) (8% vs 39%; P < .0001), and lower MGD rates (2% vs 19%; P < .0001). Operative failure was 0.3% in group 1 and 9.6% in group 2 (P < .0001).

CONCLUSION - Younger patients have a greater rate of correct localization. When SUS correlates with operative findings, MGD is significantly lower and fewer BNEs are performed. Additionally, operations are shorter with a higher success rate.

MeSH Terms (13)

Adolescent Adult Aged Aged, 80 and over False Positive Reactions Female Humans Hyperparathyroidism, Primary Male Middle Aged Parathyroid Glands Physician's Role Ultrasonography

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