Pre-operative imaging workup for surgical intervention in primary hyperparathyroidism: A tertiary referral center experience.
PURPOSE
Preoperative imaging in patients with primary hyperparathyroidism provides important localization information, allowing the surgeon to perform a focused surgery. However there are no evidence-based guidelines suggesting which preoperative imaging should be used, resulting in a risk of excessive prescription of exams and waste of economic resources. The main purpose of this study was to describe our experience on the performance of various imaging techniques for the preoperative localization of abnormal parathyroid gland/s, with a focus on the sensitivity and specificity of each technique. Secondly, we carried out an analysis of the cost utility of each technique in order to determine the most clinical and cost-effective combination of localization studies.


MATERIALS AND METHODS
Records of 336 patients who underwent parathyroidectomy were retrospectively examined comparing imaging and intraoperative/histopathologic findings to evaluate the accuracy in parathyroid detection of each imaging technique. Costs were determined by regional health system reimbursement.


RESULTS
We found that the sensitivity of color Doppler US was significantly higher than SPECT (p 0,023), while the sensitivity of 4D-CT was significantly better than US (p 0,029) and SPECT (p 0,0002).


CONCLUSIONS
In experienced hands color Doppler US is a highly sensitive technique especially in patients with no thyroid diseases. In patients with concomitant thyroid pathology, the combination of US and 4D-CT represents a reliable localization technique.
['Piccin|Ottavio|O|', "D'Alessio|Pasquale|P|", 'Cioccoloni|Eleonora|E|', 'Burgio|Luca|L|', 'Poggi|Cristina|C|', 'Altieri|Paola|P|', 'Vicennati|Valentina|V|', 'Repaci|Andrea|A|', 'Pagotto|Uberto|U|', 'Cavicchi|Ottavio|O|']
D003362:Cost-Benefit Analysis D003952:Diagnostic Imaging D005260:Female D006801:Humans D006980:Hyperthyroidism D021621:Imaging, Three-Dimensional D008297:Male D008875:Middle Aged D010280:Parathyroid Glands D016105:Parathyroidectomy D011300:Preoperative Care D012189:Retrospective Studies D012680:Sensitivity and Specificity D062606:Tertiary Care Centers D015899:Tomography, Emission-Computed, Single-Photon D014057:Tomography, X-Ray Computed D018615:Ultrasonography, Doppler, Color
Primary hyperparathyroidism Parathyroidectomy Diagnostic Parathyroid adenoma Parathyroid hyperplasia Parathyroid imaging Preoperative evaluation Surgical treatment Ultrasound