Preoperative localisation of parathyroid adenomas with mibi and ultrasonography: Is there an advantage of a combined approach?

Abstract

s / International Journal of Surgery 11 (2013) 589e685 634 ABSTRACTS Clinical teaching was provided to junior AE Countess Chester Hospital, Chester, UK. Aim: To evaluate the outcome of sialendoscopy performed at Arrowe Park DGH, and to compare this to NICE findings. Method: A first cycle audit was performed. Retrospectively, the case notes of patients undergoing sialendoscopy between December 2004 and November 2008 were reviewed. Data was collected with regards to patient demographics, presentation, operative findings, length of stay, complications and outcome. A second cycle comparing the same parameters was subsequently undertaken for patients undergoing sialendoscopy between December 2008 to August 2012. Results: 51 patients in the 1st cycle and 61 in the second were reviewed. In both there is a female preponderance and an average age of 54 and 50 respectively. Swelling is the most prevalent presentation, and the most frequent gland affected is the left parotid. 61% of cases in the 1st cycle were daycase procedures, increasing to 90% in the 2nd. In comparison to NICE findings 80-88% of our patients had symptom relief (82-87% NICE). 2-3% suffered ductal wall perforation (9% NICE) and no patients had nerve damage (1 patient NICE). Our own complication rate also decreased between the two cycles. Conclusion: The outcome of sialendoscopy at our unit is improving over time and is comparable with NICE findings. 0417: PREOPERATIVE LOCALISATION OF PARATHYROID ADENOMAS WITH MIBI AND ULTRASONOGRAPHY: IS THERE AN ADVANTAGE OF A COMBINED APPROACH? Edward Ridyard , Derek Siau , Simon Hargreaves . University of Manchester, Manchester, UK; Royal Bolton Hospital, Farnworth, UK. Aim: To identify whether the combination of MIBI and ultrasound (USS) in localising a parathyroid adenoma preoperatively is more effective than either MIBI or USS used alone as the limitations of both imaging modalities are well documented. Method: Retrospective manual analysis of patients’ operative and medical notes (n1⁄476) reviewing the position of parathyroid adenoma localised via MIBI, USS and the subsequent confirmation of parathyroid adenoma on histological evaluation. Results: The combination of MIBI and USS provided a statistically significant improvement in preoperative localisation of parathyroid adenoma over MIBI or USS used alone (p1⁄40.033 and p1⁄40.043 respectively). There was no significant correlation between tumour volume and serum calcium or serum PTH (p1⁄40.234 and p1⁄40.742 respectively). There was a significant reduction in serum calcium and serum PTH postoperatively (p1⁄4 0.05). Conclusion: The value of CRP and coagulation tests in secondary PTH remains to be seen within our results. We suggest that routine CRP and coagulation studies should not be performed on PTH patients because it does not change management and isunlikely todiagnoseanunderling coagulopathy. If bleeding disorders are suspected clotting factors are a more appropriate investigation.