Abstract
Background & Aims: Experienced surgeons
have the highest sensitivity in the localization of parathyroid adenomas in
patients with primary hyperparathyroidism. Correct preoperative localization,
however, allows unilateral neck exploration with subsequently reduced operative
time and complication rate. In this prospective study, we investigated the
accuracy of preoperative high-resolution ultrasound in combination with
colour-Doppler sonography for the detection of parathyroid lesions.
Subjects/Methods: Ninety-eight patients (mean age 59.1
years, range 15-86) who referred to our department with symptomatic
primary hyperparathyroidism were included in the study from January 1998 to
June 2002. Sonography was performed by experienced examiners. The exact
diagnosis was based on surgical findings and histology in all patients.
Results: The overall sensitivity for the sonographical
localization of the adenomas on the correct side of the neck was
86 %. Twenty-three percent of the adenomas located on the cranial
margin of the thyroid gland were diagnosed correctly, as were
92 % of the lesions located caudally
(p = 0.0001). The detection of feeding vessels was
possible by colour-Doppler sonography in 60 % of the cases. The
diagnosis was correct for 93 % of these suspected adenomas. No
vessels were detected in the remaining lesions, and only 39 % of
these tumours were diagnosed correctly (p = 0.0001).
Conclusions: High-resolution ultrasonography by
experienced examiners is a highly sensitive procedure for the preoperative
diagnosis of parathyroid adenomas in patients with primary hyperparathyroidism.
With this method, a unilateral neck exploration is sufficient in about
90 % of the patients. Additionally, detection of feeding vessels
by colour-Doppler sonography is an important indication of a parathyroid
lesion. Nontheless, the experienced surgeon remains the standard of
reference.
Zusammenfassung
Studienziel: Erfahrene Chirurgen haben die
höchste Treffergenauigkeit in der Lokalisationsdiagnostik von
Nebenschilddrüsenadenomen. Eine korrekte präoperative Lokalisation
ermöglicht die unilaterale Halsexploration mit reduzierter Operationszeit
und geringerer Komplikationsrate. In dieser prospektiven Studie wurde die
Treffergenauigkeit der hochauflösenden Sonographie in Kombination mit der
Farbdoppler-Sonographie in der präoperativen Lokalisationsdiagnostik von
Nebenschilddrüsenadenomen untersucht. Patienten/Methode: 98 Patienten mit symptomatischem
primären Hyperparathyreoidismus im mittleren Alter von 59,1 Jahren (Range
15-86) wurden von Januar 1998 bis Juni 2002 in die Studie eingeschlossen.
Die Sonographie wurde von erfahrenen Untersuchern durchgeführt, deren
Ergebnisse in allen Fällen mit der Chirurgie und der Histologie verglichen
wurden. Resultate: Die Sensitivität für die
richtige sonographische Halsseitenzuordnung der Adenome betrug
86 %. 23 % der Läsionen am kranialen
Schilddrüsenpol wurden richtig diagnostiziert gegenüber
92 % am kaudalen Pol (p = 0,0001). In
60 % der Fälle war ein Gefäßstiel nachweisbar,
dieser Befund war in 93 % richtig. Ohne
Gefäßstieldetektion war das Ergebnis nur in 39 %
korrekt (p = 0,0001). Schlussfolgerung: Die hochauflösende Sonographie in
Kombination mit der Farbdoppler-Sonographie ist in der Hand erfahrener
Untersucher hochsensitiv in der präoperativen Lokalisationsdiagnostik von
Nebenschilddrüsenadenomen bei Patienten mit primärem
Hyperparathyroidismus. Mit dieser Methode ist eine unilaterale Halsexploration
in etwa 90 % der Fälle möglich. Der Nachweis eines
Gefäßstiels ist ein zusätzliches wichtiges Zeichen für ein
Nebenschilddrüsenadenom. Der erfahrene Chirurg bleibt der
Goldstandard.
Key words
High-resolution ultrasound - colour-Doppler sonography - preoperative localization of parathyroid adenomas
Schlüsselwörter
Hochauflösende Sonographie - Farbdoppler-Sonographie - Präoperative Lokalisationsdiagnostik von
Nebenschilddrüsenadenomen
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S. Rickes, MD
Dept. of Gastroenterology, Hepatology and Endocrinology ·
University Hospital Charité (Campus Mitte)
Schumannstraße 20/21 · 10117 Berlin · Germany
·
Telefon: +49/30450514045
Fax: +49/30450514906
eMail: steffen.rickes@charite.de