Ultrasonography alone can reliably locate parathyroid tumours and facilitates minimally invasive parathyroidectomy

Abstract

INTRODUCTION Minimally invasive parathyroidectomy (MIP) is performed via a short incision (≤3cm). Previous studies have employed multiple imaging modalities including ultrasonography, sestamibi imaging and/or intraoperative parathyroid hormone assay. We present our eight-year experience of MIP using ultrasonography alone. METHODS One hundred parathyroidectomies performed by a single surgeon between April 2004 and December 2012 were identified in a prospectively maintained database. All patients underwent ultrasonography including preoperative marking of the lesion by a single radiologist. No other localising diagnostic tests were performed. RESULTS Of the 100 patients (69% female) who underwent parathyroidectomy, 93 had MIP. The median age of all cases was 58 years (range: 19-90 years). All patients exhibited an elevated parathyroid hormone level (median: 19pmol) in the presence of hypercalcaemia (median: 2.86mmol/l, range: 2.54-3.94mmol/l). Conventional surgery was indicated in seven patients owing to the need for concurrent thyroidectomy. The median operative time was 30 minutes (range: 10-130 minutes). Ultrasonography localised parathyroid tumour position correctly in 98% of patients who underwent MIP, and in 97% across both MIP and non-MIP groups. Postoperative complications requiring treatment included pancreatitis and symptomatic hypocalcaemia. Follow-up review at 6-8 weeks demonstrated that 86% of open cases (6/7) and 94% of MIP cases (87/93) were rendered normocalcaemic. CONCLUSIONS Our study is the first to demonstrate that the sole use of ultrasonography including preoperative marking can localise parathyroid tumours correctly in 98% of cases suitable for MIP.

A retrospective review of the role of B-mode and color Doppler ultrasonography in the investigation of primary hyperparathyroidism: Features that differentiate benign from malignant lesions

“…However, treatment for benign parathyroid lesions differ from parathyroid carcinoma in that minimally invasive surgery often suffices in adenomas and hyperplasia whilst radical neck surgery is required to treat carcinoma. [9][10][11] Critically, the prognosis of parathyroid carcinoma depends on the removal of the whole lesion as well as nodal clearance at the first surgical procedure. Therefore, it would be advantageous to raise suspicion of a malignant parathyroid lesion prior to surgery, allowing appropriate surgical planning and, importantly, advising the patient of the consequences of more radical surgery.…”

Study of the Ultrasound Appearance of the Normal Parathyroid Using an Intraoperative Procedure

“…It is also critical in patients with minimally invasive parathyroid surgery and focused parathyroidectomy to replace the traditional 4‐gland parathyroid exploration. The success rate of this approach is determined by studies localizing the lesions and confirming normal parathyroid glands, allowing for curative treatment and potentially minimizing the need for extensive intraoperative exploration …”

Preoperative Imaging in Primary Hyperparathyroidism: Literature Review and Recommendations

“…It should be noted that the overall sensitivity reported in this series of 71% for SPECT/CT is lower than has been reported in meta-analysis, likely due to the low rate of 20 mAs. In contrast, Butt et al [37] described their experience of using US alone and noted that is correctly identified the parathyroid adenoma in 98% of cases suitable for targeted parathyroidectomy.…”