Can Ultrasound Be Used as the Primary Screening Modality for the Localization of Parathyroid Disease prior to Surgery for Primary Hyperparathyroidism? A Review of 440 Cases

Abstract

Background/Aims: Sestamibi scintigraphy and neck ultrasonography have both been proposed as screening modalities for the detection of abnormal parathyroid glands in patients with primary hyperparathyroidism. As a result, many surgeons use both techniques prior to surgery. The goal of this study was to independently evaluate both ultrasound and sestamibi as single-modality preoperative screening tools for primary hyperparathyroidism. Methods: A retrospective review of consecutive patients who underwent surgery for primary hyperparathyroidism from January 1999 to December 2009. Imaging results were compared to surgical findings. Results: 440 patients were found to meet inclusion criteria. Sensitivities for correct localization of a single parathyroid adenoma for sestamibi versus ultrasound were: 83% (95% CI 78–86) versus 72% (95% CI 67–76). Ultrasound operator had no influence on sensitivity, and ultrasound identified nodular thyroid disease in 31% of patients. Conclusion: Ultrasonography alone can be used as the primary screening modality in patients with primary hyperparathyroidism. Ultrasound sensitivity is conserved despite operator variability, and identifies concomitant thyroid pathology.

Improvement of minimally invasive parathyroidectomy outcomes by real time ultrasonography performed by a surgeon and radiologist team.

“…However, it can be sufficient if accurate preoperative localization is performed [2,3,6,38,39]. The combination of SS and neck hUS has a 74-90% sensitivity in localizing a parathyroid adenoma [18,19,40,41].…”

The Accuracy of Ultrasound in the Pre-Operative Localisation of Parathyroid Lesions in Primary Hyperparathyroidism: A Review of the Literature

“…There are a number of factors that may impact on the performance of US in detecting parathyroid lesions including the expertise of the operator, the small size of some lesions, ectopic gland positions, multinodular thyroid goiter and parathyroid hyperplasia (Levy et al 2011;Mihai et al 2009;Ruda et al 2005). Two studies in this review referred to the impact of lesion size on sensitivity rates; Prasannan et al (2007) stated that US was more sensitive when detecting lesions over 1270 milligrams and Bhansali et al (2006) stated that sensitivity reached 92.3 per cent sensitivity for glands weighing over five grams.…”

“…The Nuclear Medicine (NM) Technetium 99m (Tc 99m ) sestamibi examination is a common imaging choice to preoperatively localize diseased parathyroid glands (Levy et al 2011). The Tc 99m sestamibi examination involves the injection of a radiopharmaceutical, made up of a radioisotope (Tc 99m ) and a pharmaceutical tracing agent (sestamibi).…”

“…The Tc 99m sestamibi examination involves the injection of a radiopharmaceutical, made up of a radioisotope (Tc 99m ) and a pharmaceutical tracing agent (sestamibi). A dual phased technique is used, where a gamma camera detects the radiation emitted from within the Parathyroid ultrasound (US) has emerged as an alternative or complementary localization procedure to NM techniques because it does not use ionizing radiation or an injection to the patient (Levy et al 2011), and has greater tolerance for patient movement. US is considered to be one of the most cost-effective, quick and easy imaging modalities, but it has demonstrated variable performance over time and between varying clinical environments (Whiting et al 2003;Mihai et al 2009) when localizing parathyroid lesions.…”

“…The size of diseased glands may be very small and therefore the successful localization of very small structures with US may be constrained by the resolution of the ultrasound system (Lo et al 2007). Older US units can be compromised by image quality compared to modern equipment, and this may have contributed to the lower rates of accuracy reported in older studies (Levy et al 2011). The use of colour Doppler ( Figure 6) to identify enlarged feeding arteries to parathyroid adenomas has also been reported to increase detection rates (Reeder et al 2002).…”