Accuracy and Role of Surgeon-performed Intraoperative Ultrasound in Minimally Invasive Open Parathyroidectomy

Background Assessment of the accuracy and the role of surgeon-performed ultrasound in comparison to expert radiology-performed ultrasound, sestamibi scanning and histologic findings. Methods From January 2006 to December 2007 we prospectively evaluated forty-two consecutive patients undergoing parathyroidectomy for primary hyperparathyroidism. One surgeon who was unaware of the preoperative imaging studies did all ultrasound examinations just prior to skin incision. The correlations between surgeon-performed ultrasound, radiology-expert ultrasound, sestamibi scanning and histologic findings were assessed. Results There were thirty-eight females (mean age: 55.9 years, range: 13-83) and four males (mean age: 41 years, range: 42-77) with biochemical evidence of primary hyperparathyroidism. Single gland disease (SGD) was histologically confirmed in thirty-six cases (85.7%) and multigland disease (MGD) in six cases (14.3%). Concordant preoperative U/S and sestamibi findings were found in thirty- four cases in SGD patients: surgeon performed U/S and expert radiology U/S were equally correct in all of these cases. In the rest two discordant cases in SGD patients, radiologist U/S was wrong in both cases, whereas sestamibi and surgeon U/S had no false results. Multigland disease had been predicted by negative findings in preoperative U/S and sestamibi in four patients and by finding more than one enlarged parathyroid glands in two patients. Surgeon U/S gave one false result in the former subgroup of MGD patients, although correctly identified multiple gland enlargements in the latter subgroup. Conclusions This study shows that surgeon-performed ultrasound compares favourably and even exceeds radiology U/S. Since this positive predictive result applies especially in SGD, intraoperative U/S had been added in the standards of care of patients with primary hyperparathyroidism in our institution