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Role of ultrasonography in the management of patients with primary hyperparathyroidism: retrospective comparison with technetium-99m sestamibi scintigraphy

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Abstract

Objective

Primary hyperparathyroidism (PHPT) is a common endocrine disorder that can be cured only by parathyroidectomy. Cervical ultrasonography and scintigraphy are the imaging studies most widely used for preoperative localization of the affected glands. The aim of this retrospective comparative study was to define the respective roles of ultrasonography and parathyroid scintigraphy in these cases.

Materials and methods

We analyzed 108 patients who had undergone parathyroidectomies for PHPT following cervical ultrasonographic and scintigraphic examinations. The ultrasound examinations were carried out by an expert physician sonographer in 61 cases and by various physician sonographers with different levels of experience in 47 cases. Sonographic and scintigraphic findings were compared with surgical findings and the diagnostic performance of the two imaging methods was evaluated by means of statistical analysis.

Results

The operator dependency of ultrasonography was confirmed by marked variations in sensitivity related to the experience of the sonographer. When sonography was performed by an expert, the sensitivity of combined use of the two methods was not significantly higher than that of sonography alone.

Conclusions

In expert hands, the diagnostic yield of ultrasound is appreciably superior. It can therefore be used as the main and possibly sole method for preoperative localization of pathological parathyroid tissues. Combined use of ultrasound and scintigraphy is not cost-effective in these cases. Scintigraphy is indicated only when the ultrasound examination produces negative results.

Riassunto

Obiettivo

L’iperparatiroidismo primitivo (PHPT) è una frequente patologia endocrina che ha come unico trattamento risolutivo quello chirurgico (paratiroidectomia). L’ecografia del collo e la scintigrafia sono gli esami strumentali più comunemente utilizzati nella localizzazione preoperatoria delle paratiroidi patologiche. Scopo di questo studio retrospettivo è definire il ruolo dell’ecografia, confrontandolo con quello della scintigrafia paratiroidea.

Materiali e metodi

108 pazienti sottoposti a intervento di paratiroidectomia per PHPT che hanno eseguito pre-operatoriamente sia l’ecografia del collo che la scintigrafia. L’ecografia è stata eseguita in 61 pazienti da un medico ecografista esperto e in 47 pazienti da più medici ecografisti con esperienza eterogenea. Gli esiti dell’ecografia e della scintigrafia sono stati confrontati con le risultanze dell’atto operatorio e i dati relativi alle loro prestazioni diagnostiche sono stati elaborati mediante analisi statistica.

Risultati

L’ecografia si è confermata metodica operatore-dipendente, dipendendo la sua sensibilità in modo marcato dall’esperienza dell’operatore. Nel caso dell’operatore esperto, l’incremento di sensibilità ottenuto con il contemporaneo uso della scintigrafia si è dimostrato poco rilevante.

Conclusioni

Se eseguita da un operatore esperto, l’ecografia ha una resa diagnostica sensibilmente superiore e può assumere il ruolo di principale ed eventualmente unica metodica di localizzazione preoperatoria delle paratiroidi patologiche. L’uso parallelo dell’ecografia e della scintigrafia risulta in tal caso non giustificato e non cost-effective. Si ritiene invece corretto esclusivamente il loro uso seriale (esecuzione della scintigrafia solamente in caso di negatività dell’ecografia).

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Conflict of interest

The authors of this paper Giovanni Mariano Vitetta, Pierluigi Neri, Andrea Chiecchio, Alessandro Carriero, Stefano Cirillo, Annalisa Balbo Mussetto, Alessandra Codegone declare that they have no conflict of interest.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). All patients provided written informed consent to enrollment in the study and to the inclusion in this article of information that could potentially lead to their identification.

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Authors and Affiliations

  1. S.C. Radiodiagnostica A.O. Ordine Mauriziano di Torino, Ospedale Umberto I, Largo Turati, 62, 10128, Turin, Italy

    Giovanni Mariano Vitetta, Stefano Cirillo & Annalisa Balbo Mussetto

  2. S.C.D.U. di Radiodiagnostica e Interventistica, Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Novara, Italy

    Pierluigi Neri & Alessandro Carriero

  3. U.O. Fisica Sanitaria A.O. Ordine Mauriziano di Torino, Ospedale Umberto I, Turin, Italy

    Andrea Chiecchio

  4. U.O. Medicina Nucleare A.O. Ordine Mauriziano di Torino, Ospedale Umberto I, Turin, Italy

    Alessandra Codegone

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  1. Giovanni Mariano Vitetta
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  2. Pierluigi Neri
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Correspondence to Giovanni Mariano Vitetta.

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Vitetta, G.M., Neri, P., Chiecchio, A. et al. Role of ultrasonography in the management of patients with primary hyperparathyroidism: retrospective comparison with technetium-99m sestamibi scintigraphy. J Ultrasound 17, 1–12 (2014). https://doi.org/10.1007/s40477-014-0067-8

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  • DOI: https://doi.org/10.1007/s40477-014-0067-8

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