TWO HUNDRED CONSECUTIVE PARATHYROID ULTRASOUND STUDIES BY A SINGLE CLINICIAN: THE IMPACT OF EXPERIENCE

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Abstract

Objective:

To assess the ability of ultrasound studies, performed by an experienced clinician, to predict surgical findings and provide precise anatomic localization of abnormal parathyroid glands.

Methods:

We retrospectively examined 200 consecutive parathyroid ultrasound studies performed by a single experienced clinician in our unit. All patients subsequently underwent parathyroidectomy, with histopathologic confirmation of abnormal parathyroid tissue. The correlation between the ultrasound and surgical findings was assessed.

Results:

Of the 200 study patients, 197 (98.5%) were cured of their disease at the initial operation. Ultrasound studies correctly predicted the surgical findings in 88% of patients, including 168 of 180 (93%) with single gland disease and 7 of 20 (35%) with multiple gland disease (MGD). In all cases in which a single adenoma was identified, precise information regarding its location relative to adjacent anatomic structures was provided. In 92% of these cases, anatomic details correlated closely with surgical findings. Ectopic and descended superior adenomas were most frequently missed. Patients with two nonlocalizing studies (scintigraphy and ultrasonography) had a >50% likelihood of having MGD.

Conclusion:

In experienced hands, parathyroid ultrasonography is a highly sensitive technique that provides both localization of enlarged parathyroid glands and precise anatomic detail. Thus, in this study, focused parathyroidectomy was possible in 76.5% of patients. MGD remains difficult to diagnose preoperatively. Nonlocalizing studies should alert the surgeon to a high probability of MGD and prompt the performance of 4-gland exploration.

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