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- Title
Use of Preoperative Imaging in Primary Hyperparathyroidism.
- Authors
Broome, David T; Naples, Robert; Bailey, Richard; Tekin, Zehra; Hamidi, Moska; Bena, James F; Morrison, Shannon L; Berber, Eren; Siperstein, Allan E; Scharpf, Joseph; Skugor, Mario
- Abstract
<bold>Context: </bold>Preoperative imaging is performed routinely to guide surgical management in primary hyperparathyroidism, but the optimal imaging modalities are debated.<bold>Objective: </bold>Our objectives were to evaluate which imaging modalities are associated with improved cure rate and higher concordance rates with intraoperative findings. A secondary aim was to determine whether additive imaging is associated with higher cure rate.<bold>Design, Setting, and Patients: </bold>This is a retrospective cohort review of 1485 adult patients during a 14-year period (2004-2017) at an academic tertiary referral center that presented for initial parathyroidectomy for de novo primary hyperparathyroidism.<bold>Main Outcome Measures: </bold>Surgical cure rate, concordance of imaging with operative findings, and imaging performance.<bold>Results: </bold>The overall cure rate was 94.1% (95% confidence interval, 0.93-0.95). Cure rate was significantly improved if sestamibi/single-photon emission computed tomography (SPECT) was concordant with operative findings (95.9% vs. 92.5%, P = 0.010). Adding a third imaging modality did not improve cure rate (1 imaging type 91.8% vs. 2 imaging types 94.4% vs. 3 imaging types 87.2%, P = 0.59). Despite having a low number of cases (n = 28), 4-dimensional (4D) CT scan outperformed (higher sensitivity, specificity, positive predictive value, negative predictive value) all imaging modalities in multiglandular disease and double adenomas, and sestamibi/SPECT in single adenomas.<bold>Conclusions: </bold>Preoperative ultrasound combined with sestamibi/SPECT were associated with the highest cure and concordance rates. If pathology was not found on ultrasound and sestamibi/SPECT, additional imaging did not improve the cure rate or concordance. 4D CT scan outperformed all imaging modalities in multiglandular disease and double adenomas, and sestamibi/SPECT in single adenomas, but these findings were underpowered.
- Subjects
SINGLE-photon emission computed tomography; HYPERPARATHYROIDISM; POSITRON emission tomography; CONFIDENCE intervals
- Publication
Journal of Clinical Endocrinology & Metabolism, 2021, Vol 106, Issue 1, pe328
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/clinem/dgaa779