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Comparative Study
. 2012 Jan;94(1):17-22.
doi: 10.1308/003588412X13171221498389.

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

S R Aspinall  1 , S Nicholson, R D Bliss, T W J Lennard
Affiliations
Comparative Study

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

S R Aspinall et al. Ann R Coll Surg Engl. 2012 Jan.

Abstract

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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Figures

Figure 1
Figure 1
Weight of pathological parathyroid glands identified correctly and incorrectly by surgeon-based ultrasonography
Figure 2
Figure 2
Volume of pathological parathyroid glands correctly and incorrectly identified by SUS
Figure 3
Figure 3
Influence of multi-gland disease on the accuracy of SUS
Figure 4
Figure 4
Influence of position of parathyroid gland on accuracy of SUS
Figure 5
Figure 5
Influence of thyroid pathology on accuracy of SUS
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