Scan-directed mini-incision focused parathyroidectomy: how accurate is accurate enough?
| Autor: | S Jabbar, Iestyn M. Shapey, Z Khan, R J Watson, J E Nicholson |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Parathyroidectomy
Male medicine.medical_specialty medicine.medical_treatment Concordance Parathyroid Diseases Parathyroid Glands/surgery 030230 surgery Focused parathyroidectomy Parathyroid Glands 03 medical and health sciences 0302 clinical medicine Postoperative Complications Minimally Invasive Surgical Procedures/adverse effects medicine Humans Minimally Invasive Surgical Procedures Parathyroid Diseases/surgery Retrospective Studies business.industry Parathyroidectomy/adverse effects Ultrasound Retrospective cohort study General Medicine medicine.disease Mini incision Treatment Outcome 030220 oncology & carcinogenesis General Surgery Surgery Female Radiology business Primary hyperparathyroidism Preoperative imaging |
| Zdroj: | Shapey, I M, Jabbar, S, Khan, Z, Nicholson, J E & Watson, R J 2017, ' Scan-directed mini-incision focused parathyroidectomy : how accurate is accurate enough? ', Annals of the Royal College of Surgeons of England, vol. 99, no. 2, pp. 123-128 . https://doi.org/10.1308/rcsann.2016.0271 |
| ISSN: | 1478-7083 |
| DOI: | 10.1308/rcsann.2016.0271 |
| Popis: | INTRODUCTION Mini-incision focused parathyroidectomy (MI-FP) is advocated as an alternative to bilateral neck exploration (BNE), owing to its reduced morbidity. The site and side of the affected gland is identified preoperatively using a combination of ultrasound and sestamibi scans. However, the acceptable degree of inter-scan concordance required to prompt MI-FP without compromising accuracy is undetermined. METHODS Accuracy of preoperative imaging was determined both individually and in combination for all parathyroidectomies (2007–2014). A grading system (excellent, good, poor) was devised to describe the interscan concordance, which was validated by the operative and histological findings. RESULTS Eighty-nine patients (17 male, 68 female) underwent parathyroidectomy (MI-FP 44, BNE 45). The accuracy of scans interpreted individually was 53% for ultrasound and 60% for sestamibi, with no difference according to surgical technique (P = 0.43, P = 1, respectively). The proportion of interscan concordance was: excellent – 35%, good – 40%, poor 25%. Combined accuracy was 100% for both excellent and good grades but only 13% for those graded poor. Similar rates of normocalcaemia were observed for MI-FP and BNE, while postoperative hypocalcaemia was five times higher in those undergoing BNE. CONCLUSIONS Reduction in the inter-scan concordance from excellent to good does not compromise accuracy. MI-FP could be successfully performed in up to 75% of patients – 25% higher than recommended in national guidelines. Focused parathyroidectomy does not compromise surgical and endocrinological outcomes but boasts a far superior complication rate. |
| Databáze: | OpenAIRE |
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