Optimizing Parathyroid Localization in Real Life: The Role of Expert-Performed Ultrasonography.

OBJECTIVE

To evaluate the accuracy of expert-performed ultrasonography (US) for preoperative localization in minimally invasive parathyroidectomy (MIP) compared with community US and other imaging modalities.

STUDY

DESIGN

Retrospective cohort study.

SETTING

Tertiary referral center for endocrine surgery.

METHODS

A retrospective, single-center diagnostic accuracy study of 227 patients with primary hyperparathyroidism who underwent surgery and pre-operative imaging by a dedicated neck radiologist (expert US). Sensitivity, specificity, and positive predictive value (PPV) were calculated, and were compared to other imaging modalities including community US, 99mTc-MIBI, SPECT-CT and 4DCT.

RESULTS

Expert US showed high sensitivity (89%), specificity (98%), and PPV (95%), correctly localizing adenomas in 89% of cases. It outperformed the sensitivity and specificity of community US (50%/95%), MIBI (75%/95%), SPECT-CT (82%/96%) and 4D-CT (52%/94%), respectively, particularly in atypical cases like ectopic adenomas (25% prevalence) and multiglandular disease (6% prevalence).

CONCLUSIONS

Expert-performed US should be considered the primary imaging modality for guiding MIP. Surgeons should consider referring patients to an expert ultrasonographer in cases of suspected ectopic adenoma, presence of multiglandular disease, before referring to 4D-CT scans or when considering bilateral neck explorations.