| Surgeon-Performed Ultrasound Is Superior to 99Tc-Sestamibi Scanning to Localize Parathyroid Adenomas in Patients with Primary Hyperparathyroidism: Results in 516 Patients over 10 Years. | |
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MedLine Citation:
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PMID: 21463783 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: Surgeon-performed cervical ultrasound (SUS) and 99Tc-sestamibi scanning (MIBI) are both useful in patients with primary hyperparathyroidism (PHPT). We sought to determine the relative contributions of SUS and MIBI to accurately predict adenoma location. STUDY DESIGN: We performed a database review of 516 patients undergoing surgery for PHPT between 2001 and 2010. SUS was performed by 1 of 3 endocrine surgeons. MIBI used 2-hour delayed anterior planar and single-photon emission computerized tomography images. Directed parathyroidectomy was performed with extent of surgery governed by intraoperative parathyroid hormone decline of 50%. RESULTS: SUS accurately localized adenomas in 87% of patients (342/392), and MIBI correctly identified their locations in 76%, 383/503 (p < 0.001). In patients who underwent SUS first, MIBI provided no additional information in 92% (144/156). In patients who underwent MIBI first, 82% of the time (176/214) SUS was unnecessary (p = 0.015). In 32 patients SUS was falsely negative. The reason for these included gland location in either the deep tracheoesophageal groove (n = 9) or the thyrothymic ligament below the clavicle (n = 5), concurrent thyroid goiter (n = 4), or thyroid cancer (n = 1). In 13 cases, the adenoma was located in a normal ultrasound-accessible location but was missed by the preoperative exam. In the 32 ultrasound false-negative cases, MIBI scans were positive in 21 (66%). Of the 516 patients, 7.6% had multigland disease. Persistent disease occurred in 4 patients (1%) and recurrent disease occurred in 6 (1.2%). CONCLUSIONS: When performed by experienced surgeons, SUS is more accurate than MIBI for predicting the location of abnormal parathyroids in PHPT patients. For patients facing first-time surgery for PHPT, we now reserve MIBI for patients with unclear or negative SUS. |
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Authors:
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Brian R Untch; Mohamed Abdelgadir Adam; Randall P Scheri; Kyla M Bennett; Darshana Dixit; Cynthia Webb; George S Leight; John A Olson |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of the American College of Surgeons Volume: 212 ISSN: 1879-1190 ISO Abbreviation: J. Am. Coll. Surg. Publication Date: 2011 Apr |
Date Detail:
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Created Date: 2011-04-05 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9431305 Medline TA: J Am Coll Surg Country: United States |
Other Details:
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Languages: eng Pagination: 522-9 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Surgery, Duke University Medical Center, Durham, NC. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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