Preoperative Location Of Parathyroid Adenomas In Primary Hyperparathyroidism: The Role of Cervical Doppler Ultrasound

Sara Amaral; Teresa Rego; Ana Palha; Nuno Carrilho; José Mário Coutinho; Paula Tavares; José Silva-Nunes

doi:10.20344/amp.18735

Authors

Sara Amaral Endocrinology, Diabetes and Metabolism Department. Centro Hospitalar Universitário Lisboa Central. Lisbon. NOVA Medical School. Faculdade de Ciências Medicas. Universidade NOVA de Lisboa. Lisbon. https://orcid.org/0000-0002-2911-9270
Teresa Rego Endocrinology, Diabetes and Metabolism Department. Centro Hospitalar Universitário Lisboa Central. Lisbon.
Ana Palha Endocrinology, Diabetes and Metabolism Department. Centro Hospitalar Universitário Lisboa Central. Lisbon. NOVA Medical School. Faculdade de Ciências Medicas. Universidade NOVA de Lisboa. Lisbon.
Nuno Carrilho Radiology Department. Centro Hospitalar Universitário Lisboa Central. Lisbon
José Mário Coutinho Endocrine Surgery Department. Centro Hospitalar Universitário Lisboa Central. Lisbon.
Paula Tavares Endocrine Surgery Department. Centro Hospitalar Universitário Lisboa Central. Lisbon.
José Silva-Nunes Endocrinology, Diabetes and Metabolism Department. Centro Hospitalar Universitário Lisboa Central. Lisbon. NOVA Medical School. Faculdade de Ciências Medicas. Universidade NOVA de Lisboa. Lisbon. Health and Technology Research Center. Escola Superior de Tecnologia da Saúde de Lisboa. Lisbon.

DOI:

https://doi.org/10.20344/amp.18735

Keywords:

Hyperparathyroidism, Primary, Parathyroid Neoplasms/diagnostic imaging, Ultrasonography, Doppler

Abstract

Introduction: Parathyroid adenoma is the most frequent cause of primary hyperparathyroidism. In recent years, the preoperative location of parathyroid adenomas allowed minimally invasive surgical techniques that have become preferred over the traditional bilateral neck exploration. The more recent guidelines on this subject highlight the role of nuclear medicine imaging tests. The aim of this study was to review the current role of Doppler ultrasound (US) in assessing the preoperative location of parathyroid adenomas in patients with primary hyperparathyroidism.
Material and Methods: Retrospective study based on data from patients with primary hyperparathyroidism that underwent parathyroidectomy between January 2013 and January 2022 at the Centro Hospitalar Universitário Lisboa Central. Statistical analysis was performed with IBM SPSS Statistics, version 26.0.0.0®.
Results: Parathyroidectomy was performed in 171 patients (77.8% females) with primary hyperparathyroidism. Cervical Doppler ultrasound was the most performed test (64.3%, n = 110) for preoperative location and detected a suspicious lesion in 98 patients (89.1%). The preoperative location of the parathyroid adenomas was assessed through the Doppler ultrasound and was compared with the surgical reports and histological findings; a correct identification was made in 76 patients (77.6%). Doppler ultrasound slightly underestimated the mean adenoma size (18.1 ± 7.7 mm preoperative versus 22 ± 8.4 mm postoperative). Calcium, parathyroid hormone levels, adenoma size and concomitant presence of thyroid nodules did not affect the accuracy of Doppler ultrasound.
Conclusion: Doppler ultrasound showed high diagnostic accuracy even in patients with nodular thyroid disease regardless of calcium and parathyroid hormone levels and adenoma size. Furthermore, its safety, affordability and availability should favor its use as first line test in primary hyperparathyroidism to assess the preoperative location of parathyroid adenomas.

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