PURPOSE: Today, minimizing the operating time makes preoperative hyperparathyroid lesion localization more valuable and it is routinely performed through ultrasound (US) and/or nuclear imaging (NI). We evaluated the accuracy of US and NI, used separately or concurrently, in the preoperative identification and localization of hyperparathyroid lesions. METHODS: Retrospectively, patients receiving a parathyroidectomy for primary hyperparathyroidism from January 1985 through August 2000 were reviewed. The demographics, operative characteristics, serum laboratories, pathology, and radiology results were evaluated. RESULTS: A total of 226 operations were performed including 160 adenomas, 64 hyperplasia, and 2 carcinomas. For US the sensitivity was 67%, specificity 33%, and positive predictive value (PPV) 82%. For NI these values were 67%, 55%, and 86%, respectively. When either US or NI were positive, the results were 82%, 29%, and 85%, respectively. When both were positive, the results were 53%, 71%, and 90%, respectively. When both were positive, and had side concordance, the results were 53%, 100%, and 100%, respectively. CONCLUSIONS: Positive NI correlated with an accurate pathologic location. Concordance of imaging tests increased specificity, PPV, and likelihood ratio. Negative localization on both imaging tests had a higher probability of being hyperplasia. Agreement of tests, especially when the side agrees, had a higher probability of adenoma.
PURPOSE: Today, minimizing the operating time makes preoperative hyperparathyroid lesion localization more valuable and it is routinely performed through ultrasound (US) and/or nuclear imaging (NI). We evaluated the accuracy of US and NI, used separately or concurrently, in the preoperative identification and localization of hyperparathyroid lesions. METHODS: Retrospectively, patients receiving a parathyroidectomy for primary hyperparathyroidism from January 1985 through August 2000 were reviewed. The demographics, operative characteristics, serum laboratories, pathology, and radiology results were evaluated. RESULTS: A total of 226 operations were performed including 160 adenomas, 64 hyperplasia, and 2 carcinomas. For US the sensitivity was 67%, specificity 33%, and positive predictive value (PPV) 82%. For NI these values were 67%, 55%, and 86%, respectively. When either US or NI were positive, the results were 82%, 29%, and 85%, respectively. When both were positive, the results were 53%, 71%, and 90%, respectively. When both were positive, and had side concordance, the results were 53%, 100%, and 100%, respectively. CONCLUSIONS: Positive NI correlated with an accurate pathologic location. Concordance of imaging tests increased specificity, PPV, and likelihood ratio. Negative localization on both imaging tests had a higher probability of being hyperplasia. Agreement of tests, especially when the side agrees, had a higher probability of adenoma.
Authors: N Jaskowiak; J A Norton; H R Alexander; J L Doppman; T Shawker; M Skarulis; S Marx; A Spiegel; D L Fraker Journal: Ann Surg Date: 1996-09 Impact factor: 12.969
Authors: Monica S Eigelberger; W Keat Cheah; Philip H G Ituarte; Leanne Streja; Quan-Yang Duh; Orlo H Clark Journal: Ann Surg Date: 2004-04 Impact factor: 12.969
Authors: Todd P W McMullen; Diana L Learoyd; David C Williams; Mark S Sywak; Stan B Sidhu; Leigh W Delbridge Journal: World J Surg Date: 2010-08 Impact factor: 3.352