Background
Pre-operative localization is the first step for focused parathyroidectomy. Surgeon-performed
ultrasonography (SUS) is used often as a single method of localization; however, when
equivocal, sestamibi (MIBI) scan is still indicated. Intra-operative differential
jugular venous sampling (DJVS) is positive in 71–80% of patients. The purpose of this
study is to evaluate the effectiveness of office based DJVS as the next method for
localization when SUS is equivocal.
Methods
Twenty-one patients with an equivocal SUS underwent office-based, SUS-guided DJVS.
The samples were collected from the most inferior portion of each internal jugular
vein and sent for standard parathormone (PTH) measurement. The side of the neck with
the highest value of serum PTH was the initial side of exploration. DJVS lateralization
was correlated retrospectively with operative findings.
Results
In 17 of 21 (81%) patients, DJVS was correct in indicating the side of the abnormal
gland. DJVS was incorrect in 2 and negative in 2 other patients. Bilateral neck explorations
were performed in only 6 of 21 patients because of either multiglandular disease (3
patients), concomitant thyroidectomy (2 patients), or surgeon's judgment (1 patient).
There were no complications from DJVS, and all patients became eucalcemic.
Conclusion
Office based DJVS is accurate and may eliminate the need for MIBI in patients with
equivocal SUS. This simple technique can shorten the pre-operative evaluation of sporadic
primary hyperparathyroidism.
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Article info
Publication history
Accepted:
September 25,
2009
Identification
Copyright
© 2009 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
