An analysis of whether surgeon-performed neck ultrasound can be used as the main localizing study in primary hyperparathyroidism

Shamil Aliyev, Orhan Agcaoglu, Erol Aksoy, Onur Birsen, Kresimira Milas, Jamie Mitchell, Allan Siperstein, Eren Berber

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background Tc-99 sestamibi (MIBI) scan is the imaging study most frequently used in primary hyperparathyroidism (PHP). Transcutaneous cervical ultrasonography (US) is the other modality used for preoperative localization. The aim of this study was to determine whether surgeon-performed neck US can be used as the primary localizing study in PHP.

Methods This was a prospective study of 1,000 consecutive patients with first-time, sporadic PHP who underwent parathyroidectomy at a tertiary academic center. All patients had surgeon-performed neck US and MIBI before bilateral neck exploration.

Results The findings at exploration were 72% single adenoma, 15% double adenoma, and 13% hyperplasia. When US suggested single-gland disease (n = 842), MIBI was concordant in 82.5%, discordant and false in 8%, negative in 7%, and discordant but correct in 2.5%. When US suggested multigland disease (n = 68), MIBI was concordant in 47%, discordant and false in 41%, and negative in 12%. When US was negative (n = 90), MIBI was positive and correct in 43%, negative in 31%, and positive but false in 26%. Surgeon-performed neck US identified unrecognized thyroid nodules in 326 patients (33%), which led to fine-needle aspiration biopsy in 161 (49%) patients and thyroid surgery in 103 (32%) patients, with a final diagnosis of thyroid cancer in 24 (7%) patients.

Conclusion Our results show that MIBI provides additional useful information in only a minority of patients with a positive US in PHP. Nevertheless, MIBI benefits about half of patients with a negative US. Because one-third of this patient population has unrecognized thyroid nodules as well, we propose that the most cost-effective algorithm would be to do US first and reserve MIBI for US-negative cases.

Original languageEnglish (US)
Pages (from-to)1127-1131
Number of pages5
JournalSurgery (United States)
Volume156
Issue number5
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

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Primary Hyperparathyroidism
Ultrasonography
Neck
Thyroid Nodule
Adenoma
Surgeons
Parathyroidectomy
Fine Needle Biopsy
Thyroid Neoplasms
Hyperplasia
Thyroid Gland
Prospective Studies
Costs and Cost Analysis

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

An analysis of whether surgeon-performed neck ultrasound can be used as the main localizing study in primary hyperparathyroidism. / Aliyev, Shamil; Agcaoglu, Orhan; Aksoy, Erol; Birsen, Onur; Milas, Kresimira; Mitchell, Jamie; Siperstein, Allan; Berber, Eren.

In: Surgery (United States), Vol. 156, No. 5, 01.11.2014, p. 1127-1131.

Research output: Contribution to journalArticle

Aliyev, S, Agcaoglu, O, Aksoy, E, Birsen, O, Milas, K, Mitchell, J, Siperstein, A & Berber, E 2014, 'An analysis of whether surgeon-performed neck ultrasound can be used as the main localizing study in primary hyperparathyroidism', Surgery (United States), vol. 156, no. 5, pp. 1127-1131. https://doi.org/10.1016/j.surg.2014.05.009
Aliyev, Shamil ; Agcaoglu, Orhan ; Aksoy, Erol ; Birsen, Onur ; Milas, Kresimira ; Mitchell, Jamie ; Siperstein, Allan ; Berber, Eren. / An analysis of whether surgeon-performed neck ultrasound can be used as the main localizing study in primary hyperparathyroidism. In: Surgery (United States). 2014 ; Vol. 156, No. 5. pp. 1127-1131.
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abstract = "Background Tc-99 sestamibi (MIBI) scan is the imaging study most frequently used in primary hyperparathyroidism (PHP). Transcutaneous cervical ultrasonography (US) is the other modality used for preoperative localization. The aim of this study was to determine whether surgeon-performed neck US can be used as the primary localizing study in PHP.Methods This was a prospective study of 1,000 consecutive patients with first-time, sporadic PHP who underwent parathyroidectomy at a tertiary academic center. All patients had surgeon-performed neck US and MIBI before bilateral neck exploration.Results The findings at exploration were 72{\%} single adenoma, 15{\%} double adenoma, and 13{\%} hyperplasia. When US suggested single-gland disease (n = 842), MIBI was concordant in 82.5{\%}, discordant and false in 8{\%}, negative in 7{\%}, and discordant but correct in 2.5{\%}. When US suggested multigland disease (n = 68), MIBI was concordant in 47{\%}, discordant and false in 41{\%}, and negative in 12{\%}. When US was negative (n = 90), MIBI was positive and correct in 43{\%}, negative in 31{\%}, and positive but false in 26{\%}. Surgeon-performed neck US identified unrecognized thyroid nodules in 326 patients (33{\%}), which led to fine-needle aspiration biopsy in 161 (49{\%}) patients and thyroid surgery in 103 (32{\%}) patients, with a final diagnosis of thyroid cancer in 24 (7{\%}) patients.Conclusion Our results show that MIBI provides additional useful information in only a minority of patients with a positive US in PHP. Nevertheless, MIBI benefits about half of patients with a negative US. Because one-third of this patient population has unrecognized thyroid nodules as well, we propose that the most cost-effective algorithm would be to do US first and reserve MIBI for US-negative cases.",
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AU - Aliyev, Shamil

AU - Agcaoglu, Orhan

AU - Aksoy, Erol

AU - Birsen, Onur

AU - Milas, Kresimira

AU - Mitchell, Jamie

AU - Siperstein, Allan

AU - Berber, Eren

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N2 - Background Tc-99 sestamibi (MIBI) scan is the imaging study most frequently used in primary hyperparathyroidism (PHP). Transcutaneous cervical ultrasonography (US) is the other modality used for preoperative localization. The aim of this study was to determine whether surgeon-performed neck US can be used as the primary localizing study in PHP.Methods This was a prospective study of 1,000 consecutive patients with first-time, sporadic PHP who underwent parathyroidectomy at a tertiary academic center. All patients had surgeon-performed neck US and MIBI before bilateral neck exploration.Results The findings at exploration were 72% single adenoma, 15% double adenoma, and 13% hyperplasia. When US suggested single-gland disease (n = 842), MIBI was concordant in 82.5%, discordant and false in 8%, negative in 7%, and discordant but correct in 2.5%. When US suggested multigland disease (n = 68), MIBI was concordant in 47%, discordant and false in 41%, and negative in 12%. When US was negative (n = 90), MIBI was positive and correct in 43%, negative in 31%, and positive but false in 26%. Surgeon-performed neck US identified unrecognized thyroid nodules in 326 patients (33%), which led to fine-needle aspiration biopsy in 161 (49%) patients and thyroid surgery in 103 (32%) patients, with a final diagnosis of thyroid cancer in 24 (7%) patients.Conclusion Our results show that MIBI provides additional useful information in only a minority of patients with a positive US in PHP. Nevertheless, MIBI benefits about half of patients with a negative US. Because one-third of this patient population has unrecognized thyroid nodules as well, we propose that the most cost-effective algorithm would be to do US first and reserve MIBI for US-negative cases.

AB - Background Tc-99 sestamibi (MIBI) scan is the imaging study most frequently used in primary hyperparathyroidism (PHP). Transcutaneous cervical ultrasonography (US) is the other modality used for preoperative localization. The aim of this study was to determine whether surgeon-performed neck US can be used as the primary localizing study in PHP.Methods This was a prospective study of 1,000 consecutive patients with first-time, sporadic PHP who underwent parathyroidectomy at a tertiary academic center. All patients had surgeon-performed neck US and MIBI before bilateral neck exploration.Results The findings at exploration were 72% single adenoma, 15% double adenoma, and 13% hyperplasia. When US suggested single-gland disease (n = 842), MIBI was concordant in 82.5%, discordant and false in 8%, negative in 7%, and discordant but correct in 2.5%. When US suggested multigland disease (n = 68), MIBI was concordant in 47%, discordant and false in 41%, and negative in 12%. When US was negative (n = 90), MIBI was positive and correct in 43%, negative in 31%, and positive but false in 26%. Surgeon-performed neck US identified unrecognized thyroid nodules in 326 patients (33%), which led to fine-needle aspiration biopsy in 161 (49%) patients and thyroid surgery in 103 (32%) patients, with a final diagnosis of thyroid cancer in 24 (7%) patients.Conclusion Our results show that MIBI provides additional useful information in only a minority of patients with a positive US in PHP. Nevertheless, MIBI benefits about half of patients with a negative US. Because one-third of this patient population has unrecognized thyroid nodules as well, we propose that the most cost-effective algorithm would be to do US first and reserve MIBI for US-negative cases.

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