A Protocolled Implementation of Upfront Ultrasound, A Stepwise Pre-Operative Imaging Regimen in Primary Hyperparathyroidism
In brief
Surgeon-performed ultrasound finds 98% of parathyroid adenomas, avoids extra scans in half
In a prospective cohort of 99 patients with primary hyperparathyroidism, surgeon-performed ultrasound alone correctly localized at least one abnormal gland in 98% of cases, allowing 49 patients to skip additional scintigraphy or PET/CT. The stepwise approach kept per-gland detection at 92.5% and could reduce radiation exposure without sacrificing surgical success.
- Journal
- Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (Q1)
- Published
- 1 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Vanessa Dedeic, Oke Gerke, Mette Bay, Jes Sloth Mathiesen, Marie Westergaard-Nielsen, Sys Vestergaard, et al.
- PMID
- 42677987
- DOI
- 10.1002/ohn.70425
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (paper of the day, 2 September 2026): Prospective cohort, stepwise imaging for primary hyperparathyroidism
Abstract
OBJECTIVE: To evaluate the sensitivity of a stepwise preoperative imaging regimen for patients with primary hyperparathyroidism. STUDY DESIGN: Prospective cohort study. SETTING: A high-volume tertiary referral center for parathyroidectomy. METHODS: Patients with primary hyperparathyroidism referred for parathyroidectomy underwent surgeon-performed ultrasound as the primary preoperative imaging examination. The diagnostic confidence of the examiner on a scale from 0 to 3 determined whether additional imaging was acquired. If ultrasound identified an enlarged parathyroid gland with certainty (score 3), the patient was booked directly for surgery. If the confidence score was <3, the patient underwent either parathyroid scintigraphy or 18F-choline PET/CT. The gold standard was the intraoperative location of pathological parathyroid glands combined with biochemical cure ≥6 months after surgery. The primary endpoint was the sensitivity of the stepwise imaging regimen per patient, irrespective of the number of acquired imaging modalities. Secondary endpoints were the sensitivity per gland and the sensitivity of the imaging regimen if the cut-off for additional imaging had been a confidence score of 1 or 2. RESULTS: Upfront ultrasound spared 49 of 99 patients (49.5%) from additional imaging and correctly localized ≥1 pathological parathyroid gland in 98.0% of patients [95% CI 92.9-99.8]. The per-gland sensitivity was 92.5% [95% CI 84.8-1.0]. When changing the cut-off to a confidence score of 2, the per-patient sensitivity remained 98.0% [95% CI 92.9-99.8]. CONCLUSION: Our study demonstrates that a stepwise imaging regimen based on upfront ultrasound by an experienced examiner can substantially reduce the number of radiation-based supplemental scans, while maintaining a high sensitivity.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.