Journal article
4D-CT facilitates focused parathyroidectomy in patients with primary hyperparathyroidism by maintaining a high negative-predictive value for uninvolved quadrants
American journal of otolaryngology, v 41(6), 102683
Nov 2020
PMID: 32862032
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Improved preoperative localization facilitates minimally invasive parathyroidectomy for removal of parathyroid lesions therefore preventing an invasive bilateral neck exploration. As 4D-CT has emerged, its high specificity has helped with preoperative parathyroid lesion localization. A high negative predictive value (NPV) would serve to further confirm parathyroid lesion localization and limit unnecessary surgical exploration. This study's objective was to determine the NPV of preoperative 4D-CT and its facilitation of minimally invasive parathyroidectomy.
A retrospective review was compiled for patients undergoing parathyroidectomy for primary hyperparathyroidism with a preoperative 4D-CT. Included patients were sorted into various groups for comparison: those with 4D-CT localizing to a single lesion, localizing to multiple lesions, and those with nonlocalizing findings; multiple hypercellular parathyroid gland versus single gland findings; extent of surgical exploration; lesion location; and patients with concomitant thyroid nodules. Negative predictive value was calculated and used to quantify the ability for 4D-CT to rule out biochemically significant parathyroid lesions.
In our review of 68 patients: sensitivity was 81.3%, specificity was 95.5%, positive predictive value was 87.1%, and negative predictive value was 93.3%. 86% had a single localizing 4D-CT, 7% had a non-localizing 4D-CT, and 7% had a multiple quadrant localizing 4D-CT. NPV for single and multi-localizing 4D-CT were 96.8% and 88.9%, respectively.
Preoperative 4D-CT has a high negative predictive value (93.3%), suggesting in the majority of cases, a quadrant with no 4D-CT radiographic findings suspicious for parathyroid is unlikely to harbor biochemically significant parathyroid lesions.
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Details
- Title
- 4D-CT facilitates focused parathyroidectomy in patients with primary hyperparathyroidism by maintaining a high negative-predictive value for uninvolved quadrants
- Creators
- Syed H.S. Naqvi - Department of Otorhinolaryngology – Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center Houston, Houston, TX 77030, United States of AmericaKaitlyn A. Brooks - Emory UniversityMark I. Knackstedt - The University of Texas Health Science Center at HoustonArturo A. Eguia - The University of Texas Health Science Center at HoustonGarren M. Low - The University of Texas Health Science Center at HoustonAmy E. Jacks - University of KansasKarim W. Asi - The University of Texas Health Science Center at HoustonMaria O. Patino - The University of Texas Health Science Center at HoustonElliot R. Friedman - The University of Texas Health Science Center at HoustonRon J. Karni - The University of Texas Health Science Center at Houston
- Publication Details
- American journal of otolaryngology, v 41(6), 102683
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Otolaryngology (and Head and Neck Surgery)
- Web of Science ID
- WOS:000600415600002
- Scopus ID
- 2-s2.0-85089884116
- Other Identifier
- 991022008086104721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Otorhinolaryngology