Ultrasonography for the endocrine surgeon: A valuable clinical tool that enhances diagnostic and therapeutic outcomes

Milas, Mira; Stephen, Antonia E.; Berber, Eren; Wagner, Kristin; Miskulin, Judiann; Siperstein, Allan

doi:10.1016/j.surg.2005.08.032

Cited by 67 publications

(64 citation statements)

References 18 publications

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“…Perioperative ultrasonography enables the surgeon to immediately correlate the ultrasonography findings with operative findings and so the surgeon ultrasonographer has a steep learning curve. 23 The volume of parathyroid operations performed by the surgeon enables experience to be accumulated quickly, particularly in high volume endocrine surgical units. Ultrasonography findings define the parathyroid in relation to the thyroid and vascular structures, facilitating incision placement and anatomical dissection as well as reducing operating time.…”

Section: Discussionmentioning

confidence: 99%

“…8,10 The availability of portable ultrasonography equipment also allows the surgeon to perform ultrasonography in the outpatient department, thereby potentially avoiding multiple hospital visits for the patient with consequent cost savings. 23 Several studies from the US and Australia have demonstrated that SUS is an effective tool in parathyroid disease. The reported sensitivities of SUS in these studies of 60-89% 7,9-13,15 are equivalent or superior to that of RUS.…”

Section: Discussionmentioning

confidence: 99%

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The impact of surgeon-based ultrasonography for parathyroid disease on a British endocrine surgical practice

Aspinall

Nicholson

et al. 2012

annals

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INTRODUCTION Surgeon-based ultrasonography (SUS) for parathyroid disease has not been widely adopted by British endocrine surgeons despite reports worldwide of accuracy in parathyroid localisation equivalent or superior to radiology-based ultrasonography (RUS). The aim of this study was to determine whether SUS might benefit parathyroid surgical practice in a British endocrine unit. METHODS Following an audit to establish the accuracy of RUS and technetium sestamibi (MIBI) in 54 patients, the accuracy of parathyroid localisation by SUS and RUS was compared prospectively with operative findings in 65 patients undergoing surgery for primary hyperparathyroidism (pHPT). RESULTS The sensitivity of RUS (40%) was below and MIBI (57%) was within the range of published results in the audit phase. The sensitivity (64%), negative predictive value (86%) and accuracy (86%) of SUS were significantly greater than RUS (37%, 77% and 78% respectively). SUS significantly increased the concordance of parathyroid localisation with MIBI (58% versus 32% with RUS). CONCLUSIONS SUS improves parathyroid localisation in a British endocrine surgical practice. It is a useful adjunct to parathyroid practice, particularly in centres without a dedicated parathyroid radiologist, and enables more patients with pHPT to benefit from minimally invasive surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The impact of surgeon-based ultrasonography for parathyroid disease on a British endocrine surgical practice

Aspinall

Nicholson

et al. 2012

annals

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“…The use of office-based S-US to localize abnormal parathyroid glands preoperatively is not new. In several published studies, sensitivity rates of 66–76% have been reported [18,19,20]. …”

Section: Introductionmentioning

confidence: 99%

Surgeon-Performed Ultrasound as Preoperative Localization Study in Patients with Primary Hyperparathyroidism

et al. 2011

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Background: Minimally invasive parathyroidectomy is the treatment of choice for single-gland primary hyperparathyroidism. However, the exact location of the abnormal gland has to be established. Sestamibi scintigraphy, computed tomography and ultrasound (US) are commonly used modalities. We describe our experience in a non-academic center with surgeon-performed US (S-US) of the neck as preoperative localization study in patients with primary hyperparathyroidism (PHPT). Methods: Patients with a biochemically proven diagnosis of PHPT and preoperative S-US were included. Data were recorded prospectively. Perioperative gland location was compared to the preoperative S-US to determine sensitivity, specificity and accuracy rates. Results: Two of the 50 patients who underwent S-US were not subjected to surgery. In 85% of the patients analyzed by S-US, the appropriate abnormal gland(s) were identified. In 11%, no gland was identified, but abnormal glands were found during surgery. Sensitivity of S-US in our hospital is 85%, with a positive predictive value of 97%. Conclusions: We achieved a satisfactory sensitivity rate. S-US provides anatomic information to the surgeon which enables a more detailed operation planning, and it is a valuable diagnostic modality for patients with PHPT in our opinion. We hope that our data encourage other centers to implement this technique as well.

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“…Another advantage of surgeon-performed US-FNAB is that of convenience to the patient. Milas 22 found that patients are generally more satisfied if clinical workup can be performed in a single visit, the so-called 'one-stop shop' scenario.…”

Section: Discussionmentioning

confidence: 99%

Surgeon-performed Ultrasound-guided Needle Biopsy of the Thyroid: A Safe and Effective Diagnostic Procedure

Law¹,

Taylor²,

Bennett³

2011

World Journal of Endocrine Surgery

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With the ready availability of good quality portable units, office-based ultrasound (US) is increasingly being utilized by endocrine surgeons in their daily practices, particularly in the management of thyroid patients. Ultrasound-guided fine needle aspiration biopsy (US-FNAB) of thyroid lesions is a useful interventional diagnostic technique which can be readily performed by endocrine surgeons as an office-based procedure offering significant convenience for the patient. A retrospective review of US-FNAB's performed in a single surgeon practice between 2006 and 2008 was undertaken particularly assessing the diagnostic outcomes and complication rates. Factors affecting FNAB outcome were tested using Chi-square test and significance defined as p < 0.05. A total of 128 FNABs were performed on 100 patients in the time period under review. Mean lesion size was 22 mm, and the majority were solid on US. US-FNAB had sensitivity of 85%, accuracy 75%. No complications were reported. A total of 14.8% of samples were reported as either malignant, atypical or with Hurthle cell findings. In this series of patients, 22% of cases proceeded to thyroidectomy, 46% of which yielded malignancy. The nondiagnostic rate was only 5.5%. Solid lesions < 2 cm were associated with higher nondiagnostic rate (p = 0.04). Surgeon-performed thyroid US-FNAB is a safe and effective procedure which compares favorably to radiologist-performed series and offers a convenient 'one-stop' process for patients. In this series, it was associated with a low nondiagnostic rate and a low complication rate. Surgeon-performed US-FNAB techniques can be easily acquired; however, structured training and appropriate credentialing are important for the maintenance of quality assurance standards.

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Ultrasonography for the endocrine surgeon: A valuable clinical tool that enhances diagnostic and therapeutic outcomes

Cited by 67 publications

References 18 publications

The impact of surgeon-based ultrasonography for parathyroid disease on a British endocrine surgical practice

The impact of surgeon-based ultrasonography for parathyroid disease on a British endocrine surgical practice

Surgeon-Performed Ultrasound as Preoperative Localization Study in Patients with Primary Hyperparathyroidism

Surgeon-performed Ultrasound-guided Needle Biopsy of the Thyroid: A Safe and Effective Diagnostic Procedure

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