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In the pre-operative evaluation of primary hyperparathyroidism, surgeon-performed ultrasound maximizes accuracy of parathyroid localization and minimizes cost
*Maria F. Bates, *Olivia Linden, *John Ludwig, Peter J Mazzaglia
Rhode Island Hospital, Providence, RI

OBJECTIVE: Pre-operative localization of enlarged parathyroid glands is routine prior to parathyroidectomy. Surgeon-performed ultrasound (SPUS) offers significant advantages over sestamibi scanning in terms of cost, streamlined patient care, and accuracy. This study compares pre-operative SPUS to sestamibi.
Design: Retrospective review of a prospectively maintained database. Hospital charge for sestamibi was \,608, and SPUS was \. Surgeon was blinded to any prior localization study results. Four gland parathyroid exploration and intra-operative parathyroid hormone (IOPTH) were routinely employed .
Setting: Single surgeon Endocrine Surgery practice in a tertiary referral teaching hospital
PARTICIPANTS: All patients operated on for the diagnosis of primary hyperparathyroidism between 2006 and 2015
MAIN OUTCOME MEASURED: Accuracy of surgeon performed ultrasound in pre-operative localization of enlarged parathyroid glands, as determined by intra-operative anatomical findings, IOPTH, and post-operative normalization of serum calcium and PTH.
Results: There were 181 patients, all of whom had SPUS. Sestamibi was performed in 152. Presence of an enlarged parathyroid was correctly predicted by SPUS in 93.4%, and by sestamibi in 77.6%. SPUS was negative 6.1% of the time, predicted an incorrect location 1.1% of the time, and missed additional enlarged glands 16% of the time. Sestamibi was negative in 21.1%, predicted an incorrect location in 2.6%, and missed additional glands in 18.4%. Based on post-op calcium and PTH levels, operative success was 98.9%. Multi-gland hyperplasia was present in 22.5%. Hyperplasia was present in 63.6% with a negative SPUS, and 28.1% with a negative sestamibi.
Conclusions: SPUS when performed by an experienced endocrine surgeon, is more accurate than sestamibi for parathyroid localization, and represents significant cost savings. SPUS combined with IOPTH or routine four gland exploration makes routine sestamibi scanning unnecessary.


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