Preoperative Location Of Parathyroid Adenomas In Primary Hyperparathyroidism: The Role of Cervical Doppler Ultrasound
Keywords:Hyperparathyroidism, Primary, Parathyroid Neoplasms/diagnostic imaging, Ultrasonography, Doppler
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 126.96.36.199®.
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.
Press DM, Siperstein AE, Berber E, Shin JJ, Metzger R, Jin J, et al. The prevalence of undiagnosed and unrecognized primary hyperparathyroidism: a population-based analysis from the electronic medical record. Surgery. 2013;154:1232-7.
Marx SJ. Hyperparathyroid and hypoparathyroid disordes. N Eng J Med. 2000;343:1863-75
Tolloczko T, Chudzinski W, Nawrot I. Surgery for primary hyperparathyroidism. Przegl Lek. 2000;57:101-3.
Ovčariček PP, Giovanella L, Gasset IC, Hindié E, Huellner M, Luster M, et al. The EANM practice guidelines for parathyroid imaging. Eur J Nucl Med Mol Imaging. 2021;48:2801-22.
Rickes S, Sitzy J, Neye H, Ocran KW, Wermke W. High-resolution ultrasound in combination with colour-doppler sonography for preoperative localization of parathyroid adenomas in patients with primary hyperparathyroidism. Ultraschall Med. 2003;24:85-9.
Johnson NA, Tublin ME, Ogilvie JB. Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. AJR Am J Roentgenol. 2007;188:1706-15.
Mohammadi A, Moloudi F, Ghasemi-rad M. Spectral doppler analysis of parathyroid adenoma: correlation between resistive index and serum parathyroid hormone concentration. AJR Am J Roentgenol. 2013;201:W318-21.
Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, et al. Consensus statement: guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the fourth international workshop. J Clin Endocrinol Metab. 2014;99:3561–9.
Mohammadi A, Moloudi F, Ghasemi-rad M. Preoperative localization of parathyroid lesion: diagnostic usefulness of color doppler ultrasonography. Int J Clin Exp Med. 2012;5:80–6.
Bunch PM, Kelly HR. Preoperative imaging techniques in primary hyperparathyroidism: a review. JAMA Otolaryngol Head Neck Surg. 2018;144:929-37.
Nasiri S, Soroush A, Hashemi AP, Hedayat A, Donboli K, Mehrkhani F. Parathyroid adenoma localization. Med J Islam Repub Iran. 2012;26:103-9.
Chandromohan A, Sathyakumar K, Irodi A, Abraham D, Paul MJ. Causes of discordant or negative ultrasound of parathyroid glands in treatment naïve patients with primary hyperparathyroidism. Eur J Radiol. 2012;81:3956-64.
Elsayed WAE, Ali RA. Efficacy of scintigraphy, ultrasound and both scintigraphy and ultrasonography in preoperative detection and localization of primary hyperparathyroidism. Cureus. 2019;11:e4960.
Ruda JM, Hollenbeak CS, Stack Jr BC. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg. 2005;132:359-72.
Lubitz CC, Chen H. Sestamibi-negative patients: to operate or image? Ann Surg Oncol. 2012;19:2086-7.
Westreich RW, Brandwein M, Mechanick JI, Bergman DA, Urken ML. Preoperative parathyroid localization: correlating false-negative technetium 99m sestamibi scans with parathyroid disease. Laryngoscope. 2003;113:567-72.
Sharma J, Mazzaglia P, Milas M, Berber E, Schuster DM, Halkar R, et al. Radionuclide imaging for hyperparathyroidism (HPT): which is the best technetium-99m sestamibi modality?. 2006;140:856-63.
Ruda JM, Stack Jr BC, Hollenbeak CS. The cost-effectiveness of additional preoperative ultrasonography or sestamibi-SPECT in patients with primary hyperparathyroidism and negative findings on sestamibi scans. Arch Otolaryngol Head Neck Surg. 2006;132:46-53.
Assante R, Zampella E, Nicolai E, Acampa W, Vergara E, Nappi C, et al. Incremental value of sestamibi SPECT/CT over dual-phase planar scintigraphy in patients with primary hyperparathyroidism and inconclusive ultrasound. Front Med. 2019;6:164.
Suh YJ, Choi JY, Kim S, Chun IK, Yun TJ, Lee KE, et al. Comparison of 4D-CT, ultrasonography, and 99mTc sestamibi SPECT/CT in localizing singlegland primary hyperparathyroidism. Otolaryngol Head Neck Surg. 2015;152:438-43.
Kluijfhout WP, Venkatesh S, Beninato T, Vriens MR, Duh Q, Wilson DM, et al. Performance of magnetic resonance imaging in the evaluation of first-time and reoperative primary hyperparathyroidism. Surgery. 2016;160:747-54.
Kunstman JW, Kirsch JD, Mahajan A, Udelsman R. Parathyroid localization and implications for clinical management. J Clin Endocrinol Metab. 2013;98:902-12.
Yazgan AK, Topaloğlu O, Çuhacı FN, Özdemir D, Alkan A, Kılıç M, et al. Mapping of parathyroid neoplasms based on grey scale ultrasound images and histopathological whole slide images. Ann Diagn Pathol. 2020;46:151492.
Beus KS, Stack Jr BC. Synchronous thyroid pathology in patients presenting with primary hyperparathyroidism. Am J Otolaryngol. 2004;25:308-12.
Wilhelm SM, Wang TS, Ruan DT, Lee JA, Asa SL, Duh QY, et al. The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. 2016;151:959-68.
Morland D, Richard C, Godard F, Deguelte S, Delemer B. Temporal uptake patterns of 18F-fluorocholine among hyperfunctioning parathyroid glands. Clin Nucl Med. 2018;43:504-5.
Bollerslev J, Rejnmark L, Zahn A, Heck A, Appelman-Dijkstra NM, Cardoso L, et al. European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE Educational Program of Parathyroid Disorders (PARAT 2021). Eur J of Endocrinol. 2022;186:R33-63.
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