Hostname: page-component-5cf477f64f-54txb Total loading time: 0 Render date: 2025-04-05T03:22:00.371Z Has data issue: false hasContentIssue false
  • English
  • Français

Efficacy of surgeon-performed, intra-operative ultrasound scan for localisation of parathyroid adenomas in patients with primary hyperparathyroidism

Published online by Cambridge University Press:  16 December 2022

A Habib Open the ORCID record for A Habib [Opens in a new window] ,
E Molena ,
C Snowden  and
J England
A Habib*
Affiliation:
Department of ENT, Hull University Hospitals NHS Trust, UK
E Molena
Affiliation:
Department of ENT, Hull University Hospitals NHS Trust, UK
C Snowden
Affiliation:
Department of Anaesthesia, Hull University Hospitals NHS Trust, UK
J England
Affiliation:
Department of ENT, Hull University Hospitals NHS Trust, UK
*
Corresponding author: A Habib, Bradford Royal Infirmary, Duckworth Ln, Bradford BD9 6RJ, UK Email: ayaazhabib@yahoo.co.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

In the UK, guidance recommends ultrasound scanning alone or in combination with sestamibi scintigraphy to guide surgery in patients with primary hyperparathyroidism. If an adenoma is localised on imaging, this can facilitate targeted or minimally invasive surgery. Surgeon-performed ultrasound scan on the operating table benefits from being performed on an anaesthetised patient with optimal positioning. The aim of this study was to investigate the efficacy of intra-operative, blinded, surgeon-performed ultrasound scan in localisation of parathyroid adenomas.

Methods

Prospective data were collected on consecutive patients undergoing surgery for primary hyperparathyroidism at a single tertiary centre from November 2019 to June 2021. Patients underwent blinded, surgeon-performed ultrasound scan under general anaesthesia immediately prior to surgery. Localisation results from pre-operative imaging and surgeon-performed ultrasound scan were then compared with the intra-operative findings.

Results

Forty-nine patients underwent surgery and were found to have single-gland disease. Sestamibi scintigraphy, radiologist-performed ultrasound scan and surgeon-performed ultrasound scan had sensitivities of 59.4, 43.75 and 73.8 per cent, respectively. Surgeon-performed ultrasound scan had a statistically significantly increased sensitivity compared with radiologist-performed ultrasound (p < 0.05).

Conclusion

Intra-operative, surgeon-performed ultrasound scan is effective in localising parathyroid adenomas and may be a useful adjunct to facilitate minimally invasive parathyroid surgery.

Keywords

ParathyroidectomyUltrasonographyProspective Studies
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 8 , August 2023 , pp. 910 - 913
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr A Habib takes responsibility for the integrity of the content of the paper

References

NICE. Hyperparathyroidism (primary): diagnosis, assessment and initial management. In: https://www.nice.org.uk/guidance/ng132 [16 February 2022]Google Scholar
Udelsman, R, Lin, Z, Donovan, P. The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism. Ann Surg 2011;253:585–91CrossRefGoogle ScholarPubMed
Mihai, R, Simon, D, Hellman, P. Imaging for primary hyperparathyroidism—an evidence-based analysis. Langenbecks Arch Surg 2009;394:765–84CrossRefGoogle ScholarPubMed
Tay, D, Das, JP, Yeh, R. Preoperative localization for primary hyperparathyroidism: a clinical review. Biomedicines 2021;9:390CrossRefGoogle ScholarPubMed
Cheung, K, Wang, TS, Farrokhyar, F, Roman, SA, Sosa, JA. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol 2012;19:577–83CrossRefGoogle ScholarPubMed
Van Husen, R, Kim, LT. Accuracy of surgeon-performed ultrasound in parathyroid localization. World J Surg 2004;28:1122–6CrossRefGoogle ScholarPubMed
Arora, S, Balash, PR, Yoo, J, Smith, GS, Prinz, RA. Benefits of surgeon-performed ultrasound for primary hyperparathyroidism. Langenbecks Arch Surg 2009;394:861–7CrossRefGoogle ScholarPubMed
Berri, RN, Lloyd, LR. Detection of parathyroid adenoma in patients with primary hyperparathyroidism: the use of office-based ultrasound in preoperative localization. Am J Surg 2006;191:311–4CrossRefGoogle ScholarPubMed
Gurney, TA, Orloff, LA. Otolaryngologist-head and neck surgeon-performed ultrasonography for parathyroid adenoma localization. Laryngoscope 2008;118:243–6CrossRefGoogle ScholarPubMed
Steward, DL, Danielson, GP, Afman, CE, Welge, JA. Parathyroid adenoma localization: surgeon-performed ultrasound versus Sestamibi. Laryngoscope 2006;116:1380–4CrossRefGoogle ScholarPubMed
Soon, PSH, Delbridge, LW, Sywak, MS, Barraclough, BM, Edhouse, P, Sidhu, SB. Surgeon performed ultrasound facilitates minimally invasive parathyroidectomy by the focused lateral mini-incision approach. World J Surg 2008;32:766–71CrossRefGoogle ScholarPubMed
Solorzano, CC, Carneiro-Pla, DM, Irvin, GL. Surgeon-performed ultrasonography as the initial and only localizing study in sporadic primary hyperparathyroidism. J Am Coll Surg 2006;202:18–24CrossRefGoogle ScholarPubMed
Van Ginhoven, TM, Morks, AN, Schepers, T, de Graaf, PW, Smit, PC. Surgeon-performed ultrasound as preoperative localization study in patients with primary hyperparathyroidism. Eur Surg Res 2011;47:70–4CrossRefGoogle ScholarPubMed
Kairys, JC, Daskalakis, C, Weigel, RJ. Surgeon-performed ultrasound for preoperative localization of abnormal parathyroid glands in patients with primary hyperparathyroidism. World J Surg 2006;30:1658–63CrossRefGoogle ScholarPubMed
Jabiev, AA, Lew, JI, Solorzano, CC. Surgeon-performed ultrasound: a single institution experience in parathyroid localization. Surgery 2009;146:569–75CrossRefGoogle ScholarPubMed
Aspinall, S, Nicholson, S, Bliss, R, Lennard, T. The impact of surgeon-based ultrasonography for parathyroid disease on a British endocrine surgical practice. Ann R Coll Surg Engl 2012;94:17–23CrossRefGoogle ScholarPubMed
Thomas, PR, Beggs, AD, Han, TS. Utility of surgeon-performed pre-operative ultrasound in the localisation of parathyroid adenomas. JRSM Cardiovasc Dis 2019;8:2048004019856950Google ScholarPubMed
Phitayakorn, R, McHenry, CR. Incidence and location of ectopic abnormal parathyroid glands. Am J Surg 2006;191:418–23CrossRefGoogle ScholarPubMed
Roy, M, Mazeh, H, Chen, H, Sippel, RS. Incidence and localization of ectopic parathyroid adenomas in previously unexplored patients. World J Surg 2013;37:102–6CrossRefGoogle ScholarPubMed
Berber, E, Parikh, RT, Ballem, N, Garner, CN, Milas, M, Siperstein, AE. Factors contributing to negative parathyroid localization: an analysis of 1000 patients. Surgery 2008;144:74–9CrossRefGoogle ScholarPubMed