Radiographic evaluation of non-localizing parathyroid adenomas

Sakeena J. Payne, Joanne E. Smucker, Michael Bruno, Louis Winner, Brian Saunders, David Goldenberg

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Purpose Patients with primary hyperparathyroidism routinely undergo preoperative imaging to localize the abnormal gland to facilitate a guided parathyroidectomy. These techniques include neck ultrasound (US), dual phase planar technetium-99 m (99mTC) sestamibi (MIBI) scans, single photon emission computed tomography (SPECT), combined SPECT/CT, and four dimensional CT scans (4D CT). Despite appropriate preoperative imaging, non-localization of abnormal glands does occur. This study aims to determine whether non-localization is the result of radiologic interpretive error or a representation of a subset of truly non-localizing parathyroid adenomas. Materials and methods A retrospective study was performed; two senior radiologists reinterpreted the preoperative imaging (US and MIBI scans) of 30 patients with initially non-localizing studies. All patients underwent parathyroidectomy for primary hyperparathyroidism at a tertiary referral center. Both radiologists were blinded to the scores of his colleague. The results were compared for inter-reader reliability using Cohen's kappa test. Results Twenty-nine of thirty nuclear studies were found to be negative on reinterpretation. The readers agreed in 86.67% of their observations, with a kappa (κ) value of 0.706 (SE = ± 0.131, 95% confidence interval for κ = 0.449-0.962). One of eighteen ultrasounds had positive localizations on reexamination, however, the inter-observer agreement was only 55.6%, with a kappa value of 0.351 (SE = ± 0.139, and 95% confidence interval for κ = 0.080-0.623). Overall, no statistically significant difference in preoperative and retrospective interpretation was found. Conclusion This study identifies a subset of parathyroid adenomas that do not localize on preoperative imaging despite sound radiographic evaluation.

Original languageEnglish (US)
Pages (from-to)217-222
Number of pages6
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume36
Issue number2
DOIs
StatePublished - Mar 1 2015

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Parathyroid Neoplasms
Four-Dimensional Computed Tomography
Parathyroidectomy
Primary Hyperparathyroidism
Confidence Intervals
Technetium Tc 99m Sestamibi
Technetium
Single-Photon Emission-Computed Tomography
Tertiary Care Centers
Ultrasonography
Neck
Retrospective Studies
Radiologists

All Science Journal Classification (ASJC) codes

  • Otorhinolaryngology

Cite this

@article{1512f0826a0a481cae03b645781eb4ab,
title = "Radiographic evaluation of non-localizing parathyroid adenomas",
abstract = "Purpose Patients with primary hyperparathyroidism routinely undergo preoperative imaging to localize the abnormal gland to facilitate a guided parathyroidectomy. These techniques include neck ultrasound (US), dual phase planar technetium-99 m (99mTC) sestamibi (MIBI) scans, single photon emission computed tomography (SPECT), combined SPECT/CT, and four dimensional CT scans (4D CT). Despite appropriate preoperative imaging, non-localization of abnormal glands does occur. This study aims to determine whether non-localization is the result of radiologic interpretive error or a representation of a subset of truly non-localizing parathyroid adenomas. Materials and methods A retrospective study was performed; two senior radiologists reinterpreted the preoperative imaging (US and MIBI scans) of 30 patients with initially non-localizing studies. All patients underwent parathyroidectomy for primary hyperparathyroidism at a tertiary referral center. Both radiologists were blinded to the scores of his colleague. The results were compared for inter-reader reliability using Cohen's kappa test. Results Twenty-nine of thirty nuclear studies were found to be negative on reinterpretation. The readers agreed in 86.67{\%} of their observations, with a kappa (κ) value of 0.706 (SE = ± 0.131, 95{\%} confidence interval for κ = 0.449-0.962). One of eighteen ultrasounds had positive localizations on reexamination, however, the inter-observer agreement was only 55.6{\%}, with a kappa value of 0.351 (SE = ± 0.139, and 95{\%} confidence interval for κ = 0.080-0.623). Overall, no statistically significant difference in preoperative and retrospective interpretation was found. Conclusion This study identifies a subset of parathyroid adenomas that do not localize on preoperative imaging despite sound radiographic evaluation.",
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Radiographic evaluation of non-localizing parathyroid adenomas. / Payne, Sakeena J.; Smucker, Joanne E.; Bruno, Michael; Winner, Louis; Saunders, Brian; Goldenberg, David.

In: American Journal of Otolaryngology - Head and Neck Medicine and Surgery, Vol. 36, No. 2, 01.03.2015, p. 217-222.

Research output: Contribution to journalArticle

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T1 - Radiographic evaluation of non-localizing parathyroid adenomas

AU - Payne, Sakeena J.

AU - Smucker, Joanne E.

AU - Bruno, Michael

AU - Winner, Louis

AU - Saunders, Brian

AU - Goldenberg, David

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N2 - Purpose Patients with primary hyperparathyroidism routinely undergo preoperative imaging to localize the abnormal gland to facilitate a guided parathyroidectomy. These techniques include neck ultrasound (US), dual phase planar technetium-99 m (99mTC) sestamibi (MIBI) scans, single photon emission computed tomography (SPECT), combined SPECT/CT, and four dimensional CT scans (4D CT). Despite appropriate preoperative imaging, non-localization of abnormal glands does occur. This study aims to determine whether non-localization is the result of radiologic interpretive error or a representation of a subset of truly non-localizing parathyroid adenomas. Materials and methods A retrospective study was performed; two senior radiologists reinterpreted the preoperative imaging (US and MIBI scans) of 30 patients with initially non-localizing studies. All patients underwent parathyroidectomy for primary hyperparathyroidism at a tertiary referral center. Both radiologists were blinded to the scores of his colleague. The results were compared for inter-reader reliability using Cohen's kappa test. Results Twenty-nine of thirty nuclear studies were found to be negative on reinterpretation. The readers agreed in 86.67% of their observations, with a kappa (κ) value of 0.706 (SE = ± 0.131, 95% confidence interval for κ = 0.449-0.962). One of eighteen ultrasounds had positive localizations on reexamination, however, the inter-observer agreement was only 55.6%, with a kappa value of 0.351 (SE = ± 0.139, and 95% confidence interval for κ = 0.080-0.623). Overall, no statistically significant difference in preoperative and retrospective interpretation was found. Conclusion This study identifies a subset of parathyroid adenomas that do not localize on preoperative imaging despite sound radiographic evaluation.

AB - Purpose Patients with primary hyperparathyroidism routinely undergo preoperative imaging to localize the abnormal gland to facilitate a guided parathyroidectomy. These techniques include neck ultrasound (US), dual phase planar technetium-99 m (99mTC) sestamibi (MIBI) scans, single photon emission computed tomography (SPECT), combined SPECT/CT, and four dimensional CT scans (4D CT). Despite appropriate preoperative imaging, non-localization of abnormal glands does occur. This study aims to determine whether non-localization is the result of radiologic interpretive error or a representation of a subset of truly non-localizing parathyroid adenomas. Materials and methods A retrospective study was performed; two senior radiologists reinterpreted the preoperative imaging (US and MIBI scans) of 30 patients with initially non-localizing studies. All patients underwent parathyroidectomy for primary hyperparathyroidism at a tertiary referral center. Both radiologists were blinded to the scores of his colleague. The results were compared for inter-reader reliability using Cohen's kappa test. Results Twenty-nine of thirty nuclear studies were found to be negative on reinterpretation. The readers agreed in 86.67% of their observations, with a kappa (κ) value of 0.706 (SE = ± 0.131, 95% confidence interval for κ = 0.449-0.962). One of eighteen ultrasounds had positive localizations on reexamination, however, the inter-observer agreement was only 55.6%, with a kappa value of 0.351 (SE = ± 0.139, and 95% confidence interval for κ = 0.080-0.623). Overall, no statistically significant difference in preoperative and retrospective interpretation was found. Conclusion This study identifies a subset of parathyroid adenomas that do not localize on preoperative imaging despite sound radiographic evaluation.

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