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Ultrasound based focused neck exploration for primary hyperparathyroidism

Published:November 18, 2016DOI:https://doi.org/10.1016/j.amjsurg.2016.11.025

      Highlights

      • Patients with primary hyperparathyroidism were selected for focused neck exploration based on ultrasound criteria.
      • All patients had a negative sestamibi scan.
      • 82% of patients undergoing successful focused neck exploration with removal of single parathyroid adenoma.

      Abstract

      Objective

      We review our experience with focused neck exploration (FNE) based on ultrasound (USN) alone, in patients with primary hyperparathyroidism (PHP) and negative sestamibi scans (SES).

      Methods

      124 patients with PHP were evaluated for FNE and studied with SES and USN. 53 patients (43%) had a negative SES. 49 of those patients (92%) were selected for FNE based on USN criteria of a single abnormal gland, .5 cm or greater, as determined by an experienced surgeon-sonographer.

      Results

      40 of 49 patients (82%) selected on USN criteria alone underwent successful FNE. Of the 9 patients who required neck exploration 6 (12%) were incorrectly localized, 2 (4%) were found to have hyperplasia, and 1 (2%) was correctly localized but not found on the initial exploration. US had a 97.5% sensitivity and a 25% specificity as a diagnostic test for single adenomas, both within the 95% confidence interval. Of those glands successfully imaged by USN, image size correlated well with the measured size of the adenoma at path, on average within 0.40 cm (Standard deviation 0.30 cm).

      Conclusion

      We feel our data show that USN provides reliable information in patient selection for FNE. The literature supports SES as a more reliable study when positive for parathyroid adenoma, but false negative rates of 30–40% have been reported. Routine use of preoperative US by experienced surgeon-sonographers would result in more patients selected for FNE vs. routine neck exploration with expected benefits.

      Keywords

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      Linked Article

      • Letter to editor in response to article entitled “Ultrasound based focused neck exploration for primary hyperparathyroidism”
        The American Journal of SurgeryVol. 214Issue 5
        • Preview
          We read with interest the article entitled “Ultrasound based focused neck exploration for primary hyperparathyroidism” by Bradley SJ et al.1 Decision making in patients who have biochemically confirmed primary hyperparathyroidism (PHPT) but negative sestamibi scan is always difficult and this can lead to improper management of such cases. A recent study has reported that endocrinologists are less likely to refer such patients to surgeons and surgeons are less likely to proceed to parathyroidectomy in such patients, despite excellent cure rates in such patients.
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