Beneficial Effect of Endocrinologist-Performed Ultrasonography on Preoperative Parathyroid Adenoma Localization

Abstract

To evaluate whether endocrinologist-performed ultrasonography improves the localization of parathyroid adenomas in patients with primary hyperparathyroidism. We performed a retrospective analysis of consecutive patients with primary hyperparathyroidism due to a single adenoma who underwent surgery at the Dokuz Eylul University Hospital in Izmir, Turkey, between January 2000 and January 2008. Data regarding the localization of adenomas were obtained from surgical reports. Neck ultrasonography was performed in all patients as first-line imaging. Parathyroid ultrasonography was performed by a staff radiologist between January 2000 and December 2004. Beginning January 2005, parathyroid ultrasonography was performed blindly by an endocrinologist in addition to the staff radiologist. In the case of discordant preoperative localization between the endocrinologist- and radiologist-performed ultrasonography, surgery was performed according to the technetium Tc 99m sestamibi (MIBI) scan and endocrinologist-performed ultrasonography localization results. A total of 156 patients with primary hyperparathyroidism due to a single adenoma were included. Of the 156 patients, 139 also underwent MIBI scan. Ultrasonography localized 102 parathyroid adenomas (65%). The accuracy of the ultrasonography was improved in patients who underwent endocrinologist-performed ultrasonography. Endocrinologist-performed ultrasonography localized the adenoma correctly in 19 patients for whom the staff radiologist had reported a negative or unsuccessful localization. When ultrasonography results were combined with the MIBI scan findings, parathyroid adenomas were again more likely to be localized in patients who underwent operation after January 2005 and thus had endocrinologist-performed ultrasonography. Our results suggest that endocrinologist-performed ultrasonography improves the preoperative localization of parathyroid adenoma.