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Correlation of surgeon-performed parathyroid ultrasound with the Perrier classification and gland weight

Lookup NU author(s): Dr Ursula Moore, Dr Jonathan Batty, Emeritus Professor Tom Lennard, Seb Aspinall


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© 2018, Springer-Verlag GmbH Germany, part of Springer Nature. Background: Ultrasound localisation of parathyroid glands correlates with gland weight. We hypothesise that gland identification is also dependent on anatomical location. Perrier et al. have described a uniform and reliable nomenclature for parathyroid locations. We aimed to correlate surgeon-performed ultrasound (SUS) with intra-operative Perrier classification and gland weight. Methods: Review of a prospectively maintained single operator SUS database of 194 patients referred with non-familial primary hyperparathyroidism (PHPT) at a tertiary centre between 2010 and 2015. Patients underwent MIBI localisation as well as on table SUS. Intra-operative pathological gland locations were classified according to the Perrier nomenclature. Results: Mean weight of pathological glands found and missed by SUS was 1.07 ± 0.1 g and 0.48 ± 0.08 g respectively (p = 0.0001, unpaired t test). The weight of glands identified was greater than that of missed glands for each of the Perrier locations (p < 0.001, Mann-Whitney). The proportion of pathological glands found at each Perrier location varied significantly (p < 0.0001, Chi Square); so we find proportionally more B-, D-, E- and F-type glands and miss more A- and C-type glands. The median weight of glands missed on SUS varied significantly across the Perrier groups (Kruskal-Wallis, p = 0.0034) and suggests that SUS can miss quite large glands (> 0.5 g) in locations B, C and F; whereas missed glands in locations A, D and E were all small (< 0.5 g). Conclusion: Whilst gland identification correlates well with gland weight, anatomical location has a significant impact on failure of localisation irrespective of gland weight. For the surgeon operating on PHPT patients with negative US localisation, particular attention should be paid to locations C, D and A as these are the sites where pathological glands are most often missed on pre-operative US.

Publication metadata

Author(s): Dordea M, Moore U, Batty J, Lennard TWJ, Aspinall SR

Publication type: Article

Publication status: Published

Journal: Langenbeck's Archives of Surgery

Year: 2018

Volume: 403

Issue: 7

Pages: 897-903

Print publication date: 01/11/2018

Online publication date: 20/10/2018

Acceptance date: 21/09/2018

ISSN (print): 1435-2443

ISSN (electronic): 1435-2451

Publisher: Springer


DOI: 10.1007/s00423-018-1714-x


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