Role of cervical ultrasonography in primary hyperparathyroidism

Abstract

Aim:To evaluate the role of USG in the preoperative localization of parathyroid adenomas in patients with symptomatic hyperparathyroidism and to compare its usefulness with that of scintigraphy scan and postoperative findings.Material and methods:Twenty-five patients with symptomatic primary hyperparathyroidism were subjected to USG of the neck and nuclear scintigraphy, followed by surgery. The results were independently analyzed and compared with per-operative findings.Results:The 25 patients had a total of 28 abnormal glands: 22 solitary adenomas, and 6 multiple adenomas (two each in three patients). USG detected 20 out of 22 solitary adenomas and three out of six multiple adenomas. USG missed five abnormal glands, two of which were in the neck and three in the mediastinum. Scintigraphy was positive in 26 abnormal glands, out of which 22 were single and four were multiple. Two abnormal glands were missed: one in the neck and one in the mediastinum.Conclusion:As limited neck dissection for primary hyperparathyroidism becomes increasingly popular, USG has been found to be a sensitive, specific, and easily available noninvasive investigation for parathyroid localization. It can be easily offered to patients as a method for preoperative localization prior to limited parathyroid surgery outside tertiary care settings.

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

“…In all studies, diagnosis was confirmed by successful surgical removal of parathyroid pathology with or without post surgical follow up histology and blood assays. Five studies additionally confirmed surgical success with follow up assays (Bhansali et al 2006;Carlier et al 2008;Lo et al 2007;Prasannan et al 2007;Shaheen et al 2008), and three studies confirmed the nature of the excised lesion(s) with histology (Mihai et al 2006;Lo et al 2007;Carlier et al 2008). …”

“…US was performed by experienced radiologists in two studies (Carlier et al 200;Lo et al 2007), experienced sonographers in two studies (Bhansali et al 2006;Sugg et al 2004), a parathyroid surgeon in one study (Prasannan et al 2007) and the operator was not specified by Mihai et al (2006) or Shaheen et al (2008). Two studies (Lo et al 2007;Shaheen et al 2008) indicated that multiple operators were involved in performing the ultrasound examinations in their studies.…”

“…Six studies compared US and NM to surgical findings (Bhansali et al 2006;Carlier et al 2008, Lo et al 2007Prasannan et al 2007;Shaheen et al 2008;Sugg et al 2004). Mihai et al (2006) differed by not directly comparing US to surgical findings, instead comparing it to NM only, then comparing NM to surgical findings.…”

“…9 Was the execution of the reference standard described in sufficient detail to permit its replication? Prasannan et al (2007) who provided no information on the execution of the Tc 99m sestamibi scan, and Shaheen et al (2008) who provided no information on the experience or credentials of the operator(s). Whilst most studies used pre-operative or post-operative hormone assays, only three studies (Bhansali et al 2006;Prasannan et al 2007;Sugg et al 2004) provided clear cut-off values for normal or abnormal assays.…”

“…Only two studies in this review, applied a standardized surgical approach for all patients (Bhansali et al 2006;Shaheen et al 2008), with a trend in the studies to mirror current clinical practice, and adjust the surgical approach (MIP or BNE), based on the results of the localization studies (Quiros et al2004). Common surgical practice is to still to use BNE in cases of suspected multiglandular disease and those with equivocal pre-operative localization (Johnson et al 2007).…”