Have an account? Please log in.
Text size: Small font Default font Larger font
.
Radiology Daily
Radiology Daily PracticalReviews.com Radiology Daily

Diagnosing Hyperparathyroidism

October 16, 2009
Written by: , Filed in: Diagnostic Imaging
  • Comments
.

Surgical treatment of hyperparathyroidism has greatly improved due to accurate preoperative localization of adenomas and localized surgical excision.

The objective of a recent study was to compare accuracy of diagnosis of hyperparathyroidism by surgeons with that of the radiologist.

The study, published in the Archives of Otolaryngology—Head & Neck Surgery, reviewed prospective interpretations by the radiologist and retrospective interpretations by the surgeons, and compared with surgical findings of hyperparathyroidism.

Experience in reading sestamibi parathyroid studies is likely a factor in accurate diagnosis of hyperparathyroidism.

Methodology
110 consecutive parathyroidectomy cases performed over a 3.5-year period were reviewed. Scanning was performed at 10 different hospitals, using early and late sestamibi imaging. Accurate reading was defined as indicating the correct side of the adenoma.

New July 2009: Diagnostic Imaging Review: For Residents, Fellows and Radiologists

The Diagnostic Imaging Review CME program highlights the fundamentals of each radiology subspecialty by incorporating recent technical and clinical advances pertinent to current practice. In addition to formal didactic lectures on practical techniques and organ systems, this program features multiple case sessions covering each of the diagnostic specialties. Click here to read more or order:

Diagnostic Imaging Review

Results
Of 82 adenomas, only 62% were correctly lateralized in the radiology report, while 31 were falsely interpreted as normal. There were 2 false-positive reports and 10 true-negatives.

In total, 76 of 82 scans were available for retrospective review by the surgeons, who were accurate in 91% of cases. Of 31 cases with false-negative interpretations by radiologists, the 2 surgeons correctly identified location in 75% and 76% of these cases.

Conclusions
Experience in reading sestamibi parathyroid studies is likely a factor in accurate interpretation.

Low accuracy of the radiologists was attributed to the fact that scans were performed prior to refinements in procedure and equipment and that the studies were performed in 10 facilities, some of which were not experienced in this type of technique or interpretation.

The authors propose that surgeons can improve localization accuracy of this study, because “…they have a more thorough understanding of developmental and clinical anatomy and are not bound to strict radiologic interpretation criteria.”

They claim that the surgeon’s lateralization of 91% exceeds published radiology values, although I doubt that this is a statistically valid difference.

Reviewer’s Comments

I am surprised that this paper was published in a reputable journal. The study design is very asymmetric; an identical pool of studies could have been presented to both groups with identical history.

The radiologists were at 10 locations and some had minimal experience, which cannot be generalized to all radiologists.

Finally, it seems odd that the paper uses laterality to define an accurate reading, and not localization to side and upper or lower pole of the thyroid, as is common in most papers.

Author: Lionel S. Zuckier, MD

Reference:
Anderson SR, Vaughn A, et al. Effectiveness of Surgeon Interpretation of Technetium Tc 99m Sestamibi Scans in Localizing Parathyroid Adenomas. Arch Otolaryngol Head Neck Surg; 2008;134 (September): 953-957

New July 2009: Diagnostic Imaging Review: For Residents, Fellows and Radiologists

The Diagnostic Imaging Review CME program highlights the fundamentals of each radiology subspecialty by incorporating recent technical and clinical advances pertinent to current practice. In addition to formal didactic lectures on practical techniques and organ systems, this program features multiple case sessions covering each of the diagnostic specialties. Click here to read more or order:

Diagnostic Imaging Review

.
  • Comments
.

Would you like to keep current with radiological news and information?

Post Your Comments and Responses

Comments are closed.