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What is the Added Benefit of Cervical Ultrasound to (99m)Tc-Sestamibi Scanning in Primary Hyperparathyroidism?
MedLine Citation:
PMID:  21509629     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Minimally invasive parathyroidectomy for primary hyperparathyroidism depends on accurate preoperative imaging, which is traditionally accomplished by (99m)Tc-sestamibi scanning. Cervical ultrasound is gaining in use, but it is unclear how much information it adds to the routine use of (99m)Tc-sestamibi scans. METHODS: A prospectively maintained database of patients undergoing parathyroidectomy for primary hyperparathyroidism was queried, and the utility of cervical ultrasound in preoperative planning was analyzed. RESULTS: Between July 2002 and November 2009, 310 patients with primary hyperparathyroidism underwent both (99m)Tc-sestamibi and ultrasound imaging. Ultrasound added new information to (99m)Tc-sestamibi in 43 patients (14%) by finding either the correct enlarged gland (n = 40, 88%) or additional enlarged glands (n = 5, 12%). Ultrasound correctly localized glands in 38 of 85 (45%) patients with a negative (99m)Tc-sestamibi, allowing for a minimally invasive parathyroidectomy in those patients. However, in the 206 patients (66%) who had a 1-gland positive (99m)Tc-sestamibi, ultrasound only added information for 8 patients (4%). When compared with radiology-performed ultrasound, surgeon-performed ultrasound was successful in localizing additional glands in 27 (15%) versus 17 patients (10%) (P < 0.001). CONCLUSIONS: Ultrasound led to additional localization information in 14% of patients, although this benefit was less in patients with a clearly positive 1-gland (99m)Tc-sestamibi scan. Cervical ultrasound provides added benefit to (99m)Tc-sestamibi scanning in patients with primary hyperparathyroidism, but its greatest utility is when performed by a surgeon in patients with a negative (99m)Tc-sestamibi scan.
Authors:
Joel T Adler; Herbert Chen; Sarah Schaefer; Rebecca S Sippel
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-21
Journal Detail:
Title:  Annals of surgical oncology     Volume:  -     ISSN:  1534-4681     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9420840     Medline TA:  Ann Surg Oncol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
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