Striving toward standardization of reporting of ultrasound features of thyroid nodules and lymph nodes: a multidisciplinary consensus statement.

BACKGROUND: The use of high-resolution ultrasound (US) imaging is a mainstay of the initial evaluation and long-term management of thyroid nodules and thyroid cancer. To fully capitalize on the diagnostic capabilities of a US examination in the context of thyroid disease, many clinicians consider it desirable to establish a universal format and standard of US reporting. The goals of this interdisciplinary consensus statement are twofold. First, to create a standardized set of US features to characterize thyroid nodules and cervical lymph nodes accurately, and second, to create a standardized system for tracking sequential changes in the US examination of thyroid nodules and cervical lymph nodes for the purpose of determining risk of malignancy. SUMMARY: The Thyroid, Head and Neck Cancer (THANC) Foundation convened a panel of nine specialists from a variety of medical disciplines that are actively involved in the diagnosis and treatment of thyroid nodules and thyroid cancer. Consensus was achieved on the following topics: US evaluation of the thyroid gland, US evaluation of thyroid nodules, US evaluation of cervical lymph nodes, US-guided fine needle aspiration (FNA) of thyroid nodules, and US-guided FNA of cervical lymph nodes. CONCLUSION: We propose that this statement represents a consensus within a multidisciplinary team on the salient and essential elements of a comprehensive and clinically significant thyroid and neck US report with regards to content, terminology, and organization. This reporting protocol supplements previous US performance guidelines by not only capturing categories of findings that may have important clinical implications, but also delineating findings that are clinically relevant within those categories as specifically as possible. Additionally, we have included the specific features of diagnostic and therapeutic interventions that have not been previously addressed.

Localization of small parathyroid adenomas using modified 4-dimensional computed tomography/ultrasound.

OBJECTIVE: To investigate whether parathyroid gland weight has an impact on the accuracy of preoperative localization of parathyroid adenomas with modified 4 dimensional computed tomography/ultrasound. And to determine if the weight of parathyroid adenomas can be calculated accurately based on the dimensions of the gland on the CT images. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care hospital. SUBJECTS AND METHODS: One hundred forty-two patients who had a preoperative modified 4-dimensional computed tomography/ultrasound and underwent parathyroidectomy for hyperparathyroidism due to a parathyroid adenoma between 1998 and 2009. Charts were reviewed to identify (1) the sensitivity and specificity for localization of parathyroid adenomas according to gland weight and (2) correlation between preoperative estimate of parathyroid weight and the surgical weight of the parathyroid gland. RESULTS: Modified 4-dimensional computed tomography/ultrasound displayed 92% sensitivity for localizing adenomas weighing <150 mg to the correct side of the neck (95% confidence interval [CI], 65%-99%), 100% sensitivity for glands weighing 150 to 500 mg (95%-100%), and 98% sensitivity for glands weighing >500 mg (92%-100%). For localization to the correct quadrant of the neck, sensitivity was 75% (95% CI, 47%-91%) for glands weighing <150 mg, 89% (79%-95%) for those weighing 150 to 500 mg, and 94% (85%-97%) for glands weighing >500 mg. A positive correlation was seen between the preoperative weight estimate based on imaging and the operative weight of the gland, with a Pearson correlation coefficient of 0.96. CONCLUSION: Modified 4-dimensional computed tomography/ultrasound can closely predict the weight of parathyroid glands preoperatively and has good sensitivity for localization of adenomas, even in glands weighing less than 150 mg.

Parathyroid localization with modified 4D-computed tomography and ultrasonography for patients with primary hyperparathyroidism.

OBJECTIVES: In this article, we report our decade-long experience in using modified 4D-computed tomography in combination with ultrasonography (Mod 4D-CT/US) to localize abnormal parathyroid glands in patients with primary hyperparathyroidism. STUDY DESIGN: Retrospective medical record review at a university-based academic medical center. METHODS: Patients with primary hyperparathyroidism who underwent a Mod 4D-CT/US and parathyroidectomy between January 1998 and May 2009 were included in the study. Results from preoperative localization studies were compared with operative findings, pathologic data, and biochemical measurements to assess the sensitivity and specificity as well as the positive and negative predictive values of Mod 4D-CT/US. RESULTS: Mod 4D-CT/US demonstrated 94% sensitivity and 96% specificity when these imaging studies were used to lateralize the hyperfunctioning parathyroid glands to one side of the neck. In regard to localizing abnormal parathyroid glands to a specific quadrant of the neck (i.e., right-left; superior-inferior), the sensitivity and specificity of Mod 4D-CT/US was 82% and 93%, respectively. Mod 4D-CT/US had a 92% positive predictive value for single-gland disease and 75% for multigland disease. The negative predictive value for single and multigland disease (MGD) were 73% and 92%, respectively. CONCLUSIONS: Mod 4D-CT/US provides excellent sensitivity and specificity in terms of localizing abnormal parathyroid glands to the correct side and quadrant in patients with primary hyperparathyroidism, and it correctly identifies many patients with MGD.

Computed tomography can guide focused exploration in select patients with primary hyperparathyroidism and negative sestamibi scanning.

BACKGROUND: The aim of this study was to analyze the utility of preoperative thin cut (2.5 mm) computed tomography (CT) in patients with primary hyperparathyroidism (PHPT) and negative sestamibi scans. METHODS: A retrospective review of patients with PHPT was conducted from the prospective parathyroid registries of 2 tertiary referral centers. Of 482 patients, 63 with negative sestamibi scanning underwent thin cut CT of the neck and were included in the final analysis. RESULTS: CT was 85% sensitive and 94% specific for correctly lateralizing the side(s) of diseased glands and 66% sensitive and 89% specific for predicting exactly the location of diseased glands. Sixty-six percent of patients underwent focused explorations, and 87% of patients underwent parathyroidectomy under local anesthesia. Pathology revealed a single adenoma in 83%, multigland disease in 14%, carcinoma in 1%, and no pathology in 2%. Average operative time was 73 minutes overall, but only 55 minutes in patients with precise CT localization (P = .02). CONCLUSION: Thin cut CT is a helpful adjunct to preoperative workup in PHPT patients who have negative sestamibi localization and permits a focused neck exploration in a high percentage of those patients.