Article ; Online: Correlation of surgeon-performed parathyroid ultrasound with the Perrier classification and gland weight.
Langenbeck's archives of surgery
2018 Volume 403, Issue 7, Page(s) 897–903
Abstract: Background: Ultrasound localisation of parathyroid glands correlates with gland weight. We hypothesise that gland identification is also dependent on anatomical location. Perrier et al. have described a uniform and reliable nomenclature for parathyroid ... ...
| Abstract | Background: Ultrasound localisation of parathyroid glands correlates with gland weight. We hypothesise that gland identification is also dependent on anatomical location. Perrier et al. have described a uniform and reliable nomenclature for parathyroid locations. We aimed to correlate surgeon-performed ultrasound (SUS) with intra-operative Perrier classification and gland weight. Methods: Review of a prospectively maintained single operator SUS database of 194 patients referred with non-familial primary hyperparathyroidism (PHPT) at a tertiary centre between 2010 and 2015. Patients underwent MIBI localisation as well as on table SUS. Intra-operative pathological gland locations were classified according to the Perrier nomenclature. Results: Mean weight of pathological glands found and missed by SUS was 1.07 ± 0.1 g and 0.48 ± 0.08 g respectively (p = 0.0001, unpaired t test). The weight of glands identified was greater than that of missed glands for each of the Perrier locations (p < 0.001, Mann-Whitney). The proportion of pathological glands found at each Perrier location varied significantly (p < 0.0001, Chi Square); so we find proportionally more B-, D-, E- and F-type glands and miss more A- and C-type glands. The median weight of glands missed on SUS varied significantly across the Perrier groups (Kruskal-Wallis, p = 0.0034) and suggests that SUS can miss quite large glands (> 0.5 g) in locations B, C and F; whereas missed glands in locations A, D and E were all small (< 0.5 g). Conclusion: Whilst gland identification correlates well with gland weight, anatomical location has a significant impact on failure of localisation irrespective of gland weight. For the surgeon operating on PHPT patients with negative US localisation, particular attention should be paid to locations C, D and A as these are the sites where pathological glands are most often missed on pre-operative US. |
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| MeSH term(s) | Adult ; Aged ; Cohort Studies ; Databases, Factual ; Female ; Follow-Up Studies ; Humans ; Hyperparathyroidism/classification ; Hyperparathyroidism/diagnostic imaging ; Hyperparathyroidism/surgery ; Male ; Middle Aged ; Monitoring, Intraoperative/methods ; Organ Size ; Parathyroid Glands/pathology ; Parathyroid Glands/surgery ; Parathyroidectomy/adverse effects ; Parathyroidectomy/methods ; Postoperative Complications/epidemiology ; Postoperative Complications/physiopathology ; Retrospective Studies ; Risk Assessment ; Treatment Outcome ; Ultrasonography, Doppler/methods ; United Kingdom |
| Language | English |
| Publishing date | 2018-10-20 |
| Publishing country | Germany |
| Document type | Journal Article |
| ZDB-ID | 1423681-3 |
| ISSN | 1435-2451 ; 1435-2443 |
| ISSN (online) | 1435-2451 |
| ISSN | 1435-2443 |
| DOI | 10.1007/s00423-018-1714-x |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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