Addressing the challenges of missed parathyroid glands in ultrasonography for secondary hyperparathyroidism.

Abstract

Abstract Background Preoperative localization plays an important role in secondary hyperparathyroidism (SHPT) surgery. The advantages of neck ultrasound (US) include high availability and low cost. However, the reported sensitivity of US is 54–76%, and the reason for missed PG on US has been rarely addressed. Methods Fifty-four patients who were diagnosed with renal SHPT from September 2020 to March 2022 were included in this retrospective study. Preoperative localization included surgeon-oriented US and technetium 99m-sestamibi single-photon-emission-computed tomography/computed tomography (SPECT/CT). Results A total of 212 parathyroid glands (PGs) were pathologically confirmed, resulting in success rate of 96.2% (52/54). Using echo, 193 (91.0%) PGs were accurately localized, while 19 (9.0%) glands were not identified, including those in ectopic positions (n = 12, at thymus or intra-thyroid or others), of a small size (< 1 cm, n = 6), or overlapping with an ipsilateral PG (n = 1). US accurately detected four PGs in 36 (66.7%) patients, while SPECT/CT localized four glands in 19 (35.2%) patients. Although the number of US-detectable PGs was not associated with success rate, it showed significant negative correlation with surgical time (rs=-0.459, P = 0.002). Conclusion US detected four glands in 66% of SHPT patients with a sensitivity of 90% for localization. Ectopic position and small size were the most common reasons of failing to detect PG on US. Complete preoperative echo localization might shorten the operating time.