Introduction: Current diagnostic procedures for thyroid cancer often yield uncertain results, lea... more Introduction: Current diagnostic procedures for thyroid cancer often yield uncertain results, leading to recurrent clinical procedures and often unwarranted surgery. Scent-trained dogs have been trained to find and alert on small concentrations of human fluids and tissues. We tested the hypothesis that a scent-trained dog could reliably detect metastatic thyroid cancer in patient urine and blood samples. Materials and Methods: The UAMS IRB and IACUC committees approved the protocol. Urine and blood samples were collected from patients after total thyroidectomy and treatment of papillary cancer. Metastatic cancer was clinically significant (‡ 1.0 cm) and documented by imaging and/or elevated thyroglobulin levels (1742 – 656 ng/mL [SE] without antibodies; range 2.2 to > 5000). All cancer patients were treated after surgery with radioactive iodine ablation. Thyroidectomy patients without thyroid cancer were identified by the pathologic absence of cancer. Our dog (male, mixed breed rescue) was imprinted on pathologically verified papillary thyroid cancer tissue obtained during surgery. Imprinting was accomplished by conditioning and positive reinforcement (rewarding for directed behaviors), and discrimination training involved the random presentation of cancer and healthy samples. The dog was rewarded with verbal excitement and a treat for correct answers. Training was conducted with scent-cones devices and evolved to solidify the dog's unique ability to identify cancer and noncancer samples. Reliability testing was accomplished by the random presentation of urine or blood samples. Each testing session included the presentation of six to eight urine and/or blood samples. Samples contained only the subject code, and the handler was blinded to the sample status (cancer vs noncancer). A gloved handler
Vitamin D has been reported in several studies to have anti-proliferative, anti-apoptotic and pro... more Vitamin D has been reported in several studies to have anti-proliferative, anti-apoptotic and pro-differentiating effects in several tumor types. The role of vitamin D in the incidence and/or progression of thyroid malignancy remain largely unknown. We performed a retrospective chart review of postoperative 25-hydroxyvitamin D levels from 255 subjects receiving total (n=197) or completion (n=58) thyroidectomy for benign (n=190) and malignant (n=65) disease at the University of Arkansas for Medical Sciences between October 2005 and July 2013. No significant difference (P = 0.72) was observed between postoperative 25-hydroxyvitamin D levels in subjects with malignant pathology (median 25 ng/mL; range 21-37 ng/ml) versus benign pathology (median 27 ng/ml; range 19.5-35 ng/ml). In our limited study, there was no correlation between postoperative 25-hydroxyvitamin D status and pathological findings in subjects undergoing thyroidectomy.
The role of infection in the etiology of bisphosphonate-related osteonecrosis of the jaw (BRONJ) ... more The role of infection in the etiology of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is poorly understood. Large-scale epidemiological descriptions of the histology and microbiology of BRONJ are not found in the literature. Herein, we present a systematic review of BRONJ histology and microbiology (including demographics, immunocompromised associations, clinical signs and symptoms, disease severity, antibiotic and surgical treatments, and recovery status) validating that infection should still be considered a prime component in the multifactorial disease.
OBJECTIVES: To measure the effect of proton pump inhibitors (PPIs), with and without concurrent b... more OBJECTIVES: To measure the effect of proton pump inhibitors (PPIs), with and without concurrent bisphospho-nates, on parathyroid hormone (PTH), vitamin D, and calcium. DESIGN: Retrospective chart review of individuals 60 years and older. Subjects with reduced renal function (creatinine >1.3 mg/dL) and low vitamin D (<30 ng/mL) were excluded. SETTING: Academic geriatric outpatient center in southern midwest. PARTICIPANTS: Individuals aged 60 and older with concurrent calcium, PTH, vitamin D, and creatinine laboratory measurements (N = 80) meeting labeled criteria. MEASUREMENTS: Serum calcium, PTH, vitamin D, and creatinine. RESULTS: Chronic PPI exposure was associated with statistically significantly higher PTH (65.5 vs 30.3 pg/mL, P < .001; normal range 10–55 pg/mL) and lower calcium (9.1 vs 9.4 mg/dL, P = .02; normal range 8.5–10.5 mg/dL) than no PPI exposure. Chronic PPI exposure with concurrent BP therapy was associated with statistically significantly higher PTH (65.2 vs 43.4 pg/mL, P = .05) and lower calcium (9.2 vs 9.6 mg/dL, P = .04) than BP therapy only. CONCLUSION: Based on the present study, chronic PPI exposure in elderly adults is associated with mild hyper-parathyroidism regardless of concurrent oral BP administration. J Am Geriatr Soc 2015.
Thyroid surgery is increasingly being performed by high-volume centers demonstrating higher cure ... more Thyroid surgery is increasingly being performed by high-volume centers demonstrating higher cure rates, fewer complications, lower mortality, and shorter hospital stays. The University HealthSystem Consortium (UHC) database was used to generate a descriptive report of geographic trends in distance traveled for care and thyroidectomy volume across the US. The UHC represents 90% of non-profit academic medical centers and more than 300 of their affiliated hospitals. UHC data from 2010 to 2013 were compiled. 67,374 patients undergoing thyroid surgery in the US were identified. The patient’s state of residence versus state where surgery was performed, age, sex, race, insurance, comorbidities, complications, discharge status, length of stay, and location (state specific) of hospital admission were collected. Ten percent of Americans undergoing thyroidectomy traveled to another state for surgery. Less than 3% of patients traveled to another region of the US (Northeast, Midwest, South, West...
In a prior study, we demonstrated that canines could reliably discriminate between urine samples ... more In a prior study, we demonstrated that canines could reliably discriminate between urine samples obtained from subjects previously diagnosed with either metastatic thyroid carcinoma (PTC) or benign thyroid disease1. In order to test the ability of canines to prospectively detect thyroid cancer in undiagnosed subjects, urine was collected (February 2014 to November 2014) from 59 subjects who presented to our thyroid clinic with > 1 thyroid nodule(s) suspicious for thyroid cancer. Prior to testing, a canine was imprinted with urine, blood and thyroid tissue obtained from multiple patients with PTC, and trained over 6 months to discriminate between PTC and benign urine samples. In the lab, a gloved handler, blinded to the sample status, presented each unknown sample in a 3-mL cryotube to the canine. The handler verbally communicated the canine’s alert (if PTC, the canine laid down) to a blinded study coordinator who recorded the response. Known control samples (both cancer and benig...
The University HealthSystem Consortium (UHC) database was interrogated to generate a descriptive ... more The University HealthSystem Consortium (UHC) database was interrogated to generate a descriptive report of trends in robotic thyroidectomy in the US surrounding the announcement of FDA restrictions for the use of the robot in thyroid surgery in the fall of 2011. UHC represents 90% of non-profit academic medical centers in the US, consisting of 120 university medical centers and more than 300 of their affiliated hospitals (www.uhc.edu). UHC data is compiled from discharge summaries into a set of comparative demographic, charges, and procedural data. Data from UHC and another North American institution not included in the UHC database from 1st Q 2009 to 4th Q 2013 (a total of 20 quarters) was compiled. 484 patients undergoing robotic thyroidectomy were identified. Data on age, sex, race, insurance, comorbidities, complications, discharge status, length of stay, and ICU admission were collected. Data on outpatient discharge type, surgeon cost, OR time, and total cost, although incomple...
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2016
To describe a safe and effective postoperative prophylactic calcium regimen for same-day discharg... more To describe a safe and effective postoperative prophylactic calcium regimen for same-day discharge thyroid and parathyroid surgery. Case series with chart review. Tertiary referral academic institution. In total, 162 adult patients who underwent total thyroidectomy, completion thyroidectomy, unilateral parathyroidectomy, parathyroidectomy with bilateral neck exploration, or revision parathyroidectomy were identified preoperatively to be candidates for same-day discharge. All patients in this study were successfully discharged the same day on our standard prophylactic calcium regimen. Less than 1% (1/162) of patients re-presented to the hospital within 30 days of surgery, and that patient was successfully discharged from the emergency department after negative workup for hypocalcemia. There was no significant difference between preoperative and postoperative calcium levels in the total/completion thyroidectomy groups (9.3 vs 9.2 mg/dL, respectively; P = .14). The average postoperativ...
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, Jan 24, 2015
To determine differences in the mean parathyroid hormone (PTH) levels for normocalcemic and hypoc... more To determine differences in the mean parathyroid hormone (PTH) levels for normocalcemic and hypocalcemic total thyroidectomy patients who were tested for PTH during the intraoperative or early postoperative period. MEDLINE, the Cochrane Database, and other databases from 1960 to 2014 in the English language and specific to humans for relevant articles. Studies were included if PTH was obtained within 24 hours of thyroidectomy. Studies were excluded (1) if only a hemithyroidectomy was performed, (2) if means of studied PTH values were not reported in the article, or (3) if the time of the PTH draw fell outside of defined "intraoperative" or "early postoperative" windows. PTH values were divided into 3 groups: preoperative (control group), intraoperative (ie, discharge decisions were based on PTH values drawn in the operating room), and early postoperative (ie, PTH values at 1 to 4 hours after surgery were used as a guide). The reported means of perioperative PTH l...
To measure the effect of proton pump inhibitors (PPIs), with and without concurrent bisphosphonat... more To measure the effect of proton pump inhibitors (PPIs), with and without concurrent bisphosphonates, on parathyroid hormone (PTH), vitamin D, and calcium. Retrospective chart review of individuals 60 years and older. Subjects with reduced renal function (creatinine &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1.3 mg/dL) and low vitamin D (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;30 ng/mL) were excluded. Academic geriatric outpatient center in southern midwest. Individuals aged 60 and older with concurrent calcium, PTH, vitamin D, and creatinine laboratory measurements (N = 80) meeting labeled criteria. Serum calcium, PTH, vitamin D, and creatinine. Chronic PPI exposure was associated with statistically significantly higher PTH (65.5 vs 30.3 pg/mL, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001; normal range 10-55 pg/mL) and lower calcium (9.1 vs 9.4 mg/dL, P = .02; normal range 8.5-10.5 mg/dL) than no PPI exposure. Chronic PPI exposure with concurrent BP therapy was associated with statistically significantly higher PTH (65.2 vs 43.4 pg/mL, P = .05) and lower calcium (9.2 vs 9.6 mg/dL, P = .04) than BP therapy only. Based on the present study, chronic PPI exposure in elderly adults is associated with mild hyperparathyroidism regardless of concurrent oral BP administration.
Tumors of the human thyroid follicular cell demonstrate multiple &quot;routes&quot; and m... more Tumors of the human thyroid follicular cell demonstrate multiple &quot;routes&quot; and multiple stages of development, offering an unparalleled opportunity for correlating clinicopathologic tumor behavior with the underlying molecular genetic abnormalities. This review summarizes the clinical and experimental evidence supporting the causal role of five key genes in thyroid oncogenesis, namely, the oncogenes ras, gsp, ret, and trk, and the tumor-suppressor gene TP53. The nature of the somatic mutations is described and the likely mechanisms discussed by which they perturb cellular growth signal transduction to produce particular pathologic phenotypes. A model of thyroid oncogenesis is presented that suggests that the pattern of tumor development is determined by the nature of the initiating oncogenic event.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, Jan 6, 2015
To evaluate 4-dimensional (4D) computed tomography (CT) for the localization of parathyroid adeno... more To evaluate 4-dimensional (4D) computed tomography (CT) for the localization of parathyroid adenomas previously considered nonlocalizing on ultrasound and single-photon emission CT with CT scanning (SPECT-CT). To measure radiation exposure associated with 4D-CT and compared it with SPECT-CT. Case series with chart review. University tertiary hospital. Nineteen adults with primary hyperparathyroidism who underwent preoperative 4D CT from November 2013 through July 2014 after nonlocalizing preoperative ultrasound and technetium-99m SPECT-CT scans. Sensitivity, specificity, predictive values, and accuracy of 4D CT were evaluated. Nineteen patients (16 women and 3 men) were included with a mean age of 66 years (range, 39-80 years). Mean preoperative parathyroid hormone level was 108.5 pg/mL (range, 59.3-220.9 pg/mL), and mean weight of the excised gland was 350 mg (range, 83-797 mg). 4D CT sensitivity and specificity for localization to the patient's correct side of the neck were 84...
Introduction: Current diagnostic procedures for thyroid cancer often yield uncertain results, lea... more Introduction: Current diagnostic procedures for thyroid cancer often yield uncertain results, leading to recurrent clinical procedures and often unwarranted surgery. Scent-trained dogs have been trained to find and alert on small concentrations of human fluids and tissues. We tested the hypothesis that a scent-trained dog could reliably detect metastatic thyroid cancer in patient urine and blood samples. Materials and Methods: The UAMS IRB and IACUC committees approved the protocol. Urine and blood samples were collected from patients after total thyroidectomy and treatment of papillary cancer. Metastatic cancer was clinically significant (‡ 1.0 cm) and documented by imaging and/or elevated thyroglobulin levels (1742 – 656 ng/mL [SE] without antibodies; range 2.2 to > 5000). All cancer patients were treated after surgery with radioactive iodine ablation. Thyroidectomy patients without thyroid cancer were identified by the pathologic absence of cancer. Our dog (male, mixed breed rescue) was imprinted on pathologically verified papillary thyroid cancer tissue obtained during surgery. Imprinting was accomplished by conditioning and positive reinforcement (rewarding for directed behaviors), and discrimination training involved the random presentation of cancer and healthy samples. The dog was rewarded with verbal excitement and a treat for correct answers. Training was conducted with scent-cones devices and evolved to solidify the dog's unique ability to identify cancer and noncancer samples. Reliability testing was accomplished by the random presentation of urine or blood samples. Each testing session included the presentation of six to eight urine and/or blood samples. Samples contained only the subject code, and the handler was blinded to the sample status (cancer vs noncancer). A gloved handler
Vitamin D has been reported in several studies to have anti-proliferative, anti-apoptotic and pro... more Vitamin D has been reported in several studies to have anti-proliferative, anti-apoptotic and pro-differentiating effects in several tumor types. The role of vitamin D in the incidence and/or progression of thyroid malignancy remain largely unknown. We performed a retrospective chart review of postoperative 25-hydroxyvitamin D levels from 255 subjects receiving total (n=197) or completion (n=58) thyroidectomy for benign (n=190) and malignant (n=65) disease at the University of Arkansas for Medical Sciences between October 2005 and July 2013. No significant difference (P = 0.72) was observed between postoperative 25-hydroxyvitamin D levels in subjects with malignant pathology (median 25 ng/mL; range 21-37 ng/ml) versus benign pathology (median 27 ng/ml; range 19.5-35 ng/ml). In our limited study, there was no correlation between postoperative 25-hydroxyvitamin D status and pathological findings in subjects undergoing thyroidectomy.
The role of infection in the etiology of bisphosphonate-related osteonecrosis of the jaw (BRONJ) ... more The role of infection in the etiology of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is poorly understood. Large-scale epidemiological descriptions of the histology and microbiology of BRONJ are not found in the literature. Herein, we present a systematic review of BRONJ histology and microbiology (including demographics, immunocompromised associations, clinical signs and symptoms, disease severity, antibiotic and surgical treatments, and recovery status) validating that infection should still be considered a prime component in the multifactorial disease.
OBJECTIVES: To measure the effect of proton pump inhibitors (PPIs), with and without concurrent b... more OBJECTIVES: To measure the effect of proton pump inhibitors (PPIs), with and without concurrent bisphospho-nates, on parathyroid hormone (PTH), vitamin D, and calcium. DESIGN: Retrospective chart review of individuals 60 years and older. Subjects with reduced renal function (creatinine >1.3 mg/dL) and low vitamin D (<30 ng/mL) were excluded. SETTING: Academic geriatric outpatient center in southern midwest. PARTICIPANTS: Individuals aged 60 and older with concurrent calcium, PTH, vitamin D, and creatinine laboratory measurements (N = 80) meeting labeled criteria. MEASUREMENTS: Serum calcium, PTH, vitamin D, and creatinine. RESULTS: Chronic PPI exposure was associated with statistically significantly higher PTH (65.5 vs 30.3 pg/mL, P < .001; normal range 10–55 pg/mL) and lower calcium (9.1 vs 9.4 mg/dL, P = .02; normal range 8.5–10.5 mg/dL) than no PPI exposure. Chronic PPI exposure with concurrent BP therapy was associated with statistically significantly higher PTH (65.2 vs 43.4 pg/mL, P = .05) and lower calcium (9.2 vs 9.6 mg/dL, P = .04) than BP therapy only. CONCLUSION: Based on the present study, chronic PPI exposure in elderly adults is associated with mild hyper-parathyroidism regardless of concurrent oral BP administration. J Am Geriatr Soc 2015.
Thyroid surgery is increasingly being performed by high-volume centers demonstrating higher cure ... more Thyroid surgery is increasingly being performed by high-volume centers demonstrating higher cure rates, fewer complications, lower mortality, and shorter hospital stays. The University HealthSystem Consortium (UHC) database was used to generate a descriptive report of geographic trends in distance traveled for care and thyroidectomy volume across the US. The UHC represents 90% of non-profit academic medical centers and more than 300 of their affiliated hospitals. UHC data from 2010 to 2013 were compiled. 67,374 patients undergoing thyroid surgery in the US were identified. The patient’s state of residence versus state where surgery was performed, age, sex, race, insurance, comorbidities, complications, discharge status, length of stay, and location (state specific) of hospital admission were collected. Ten percent of Americans undergoing thyroidectomy traveled to another state for surgery. Less than 3% of patients traveled to another region of the US (Northeast, Midwest, South, West...
In a prior study, we demonstrated that canines could reliably discriminate between urine samples ... more In a prior study, we demonstrated that canines could reliably discriminate between urine samples obtained from subjects previously diagnosed with either metastatic thyroid carcinoma (PTC) or benign thyroid disease1. In order to test the ability of canines to prospectively detect thyroid cancer in undiagnosed subjects, urine was collected (February 2014 to November 2014) from 59 subjects who presented to our thyroid clinic with > 1 thyroid nodule(s) suspicious for thyroid cancer. Prior to testing, a canine was imprinted with urine, blood and thyroid tissue obtained from multiple patients with PTC, and trained over 6 months to discriminate between PTC and benign urine samples. In the lab, a gloved handler, blinded to the sample status, presented each unknown sample in a 3-mL cryotube to the canine. The handler verbally communicated the canine’s alert (if PTC, the canine laid down) to a blinded study coordinator who recorded the response. Known control samples (both cancer and benig...
The University HealthSystem Consortium (UHC) database was interrogated to generate a descriptive ... more The University HealthSystem Consortium (UHC) database was interrogated to generate a descriptive report of trends in robotic thyroidectomy in the US surrounding the announcement of FDA restrictions for the use of the robot in thyroid surgery in the fall of 2011. UHC represents 90% of non-profit academic medical centers in the US, consisting of 120 university medical centers and more than 300 of their affiliated hospitals (www.uhc.edu). UHC data is compiled from discharge summaries into a set of comparative demographic, charges, and procedural data. Data from UHC and another North American institution not included in the UHC database from 1st Q 2009 to 4th Q 2013 (a total of 20 quarters) was compiled. 484 patients undergoing robotic thyroidectomy were identified. Data on age, sex, race, insurance, comorbidities, complications, discharge status, length of stay, and ICU admission were collected. Data on outpatient discharge type, surgeon cost, OR time, and total cost, although incomple...
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2016
To describe a safe and effective postoperative prophylactic calcium regimen for same-day discharg... more To describe a safe and effective postoperative prophylactic calcium regimen for same-day discharge thyroid and parathyroid surgery. Case series with chart review. Tertiary referral academic institution. In total, 162 adult patients who underwent total thyroidectomy, completion thyroidectomy, unilateral parathyroidectomy, parathyroidectomy with bilateral neck exploration, or revision parathyroidectomy were identified preoperatively to be candidates for same-day discharge. All patients in this study were successfully discharged the same day on our standard prophylactic calcium regimen. Less than 1% (1/162) of patients re-presented to the hospital within 30 days of surgery, and that patient was successfully discharged from the emergency department after negative workup for hypocalcemia. There was no significant difference between preoperative and postoperative calcium levels in the total/completion thyroidectomy groups (9.3 vs 9.2 mg/dL, respectively; P = .14). The average postoperativ...
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, Jan 24, 2015
To determine differences in the mean parathyroid hormone (PTH) levels for normocalcemic and hypoc... more To determine differences in the mean parathyroid hormone (PTH) levels for normocalcemic and hypocalcemic total thyroidectomy patients who were tested for PTH during the intraoperative or early postoperative period. MEDLINE, the Cochrane Database, and other databases from 1960 to 2014 in the English language and specific to humans for relevant articles. Studies were included if PTH was obtained within 24 hours of thyroidectomy. Studies were excluded (1) if only a hemithyroidectomy was performed, (2) if means of studied PTH values were not reported in the article, or (3) if the time of the PTH draw fell outside of defined "intraoperative" or "early postoperative" windows. PTH values were divided into 3 groups: preoperative (control group), intraoperative (ie, discharge decisions were based on PTH values drawn in the operating room), and early postoperative (ie, PTH values at 1 to 4 hours after surgery were used as a guide). The reported means of perioperative PTH l...
To measure the effect of proton pump inhibitors (PPIs), with and without concurrent bisphosphonat... more To measure the effect of proton pump inhibitors (PPIs), with and without concurrent bisphosphonates, on parathyroid hormone (PTH), vitamin D, and calcium. Retrospective chart review of individuals 60 years and older. Subjects with reduced renal function (creatinine &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1.3 mg/dL) and low vitamin D (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;30 ng/mL) were excluded. Academic geriatric outpatient center in southern midwest. Individuals aged 60 and older with concurrent calcium, PTH, vitamin D, and creatinine laboratory measurements (N = 80) meeting labeled criteria. Serum calcium, PTH, vitamin D, and creatinine. Chronic PPI exposure was associated with statistically significantly higher PTH (65.5 vs 30.3 pg/mL, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001; normal range 10-55 pg/mL) and lower calcium (9.1 vs 9.4 mg/dL, P = .02; normal range 8.5-10.5 mg/dL) than no PPI exposure. Chronic PPI exposure with concurrent BP therapy was associated with statistically significantly higher PTH (65.2 vs 43.4 pg/mL, P = .05) and lower calcium (9.2 vs 9.6 mg/dL, P = .04) than BP therapy only. Based on the present study, chronic PPI exposure in elderly adults is associated with mild hyperparathyroidism regardless of concurrent oral BP administration.
Tumors of the human thyroid follicular cell demonstrate multiple &quot;routes&quot; and m... more Tumors of the human thyroid follicular cell demonstrate multiple &quot;routes&quot; and multiple stages of development, offering an unparalleled opportunity for correlating clinicopathologic tumor behavior with the underlying molecular genetic abnormalities. This review summarizes the clinical and experimental evidence supporting the causal role of five key genes in thyroid oncogenesis, namely, the oncogenes ras, gsp, ret, and trk, and the tumor-suppressor gene TP53. The nature of the somatic mutations is described and the likely mechanisms discussed by which they perturb cellular growth signal transduction to produce particular pathologic phenotypes. A model of thyroid oncogenesis is presented that suggests that the pattern of tumor development is determined by the nature of the initiating oncogenic event.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, Jan 6, 2015
To evaluate 4-dimensional (4D) computed tomography (CT) for the localization of parathyroid adeno... more To evaluate 4-dimensional (4D) computed tomography (CT) for the localization of parathyroid adenomas previously considered nonlocalizing on ultrasound and single-photon emission CT with CT scanning (SPECT-CT). To measure radiation exposure associated with 4D-CT and compared it with SPECT-CT. Case series with chart review. University tertiary hospital. Nineteen adults with primary hyperparathyroidism who underwent preoperative 4D CT from November 2013 through July 2014 after nonlocalizing preoperative ultrasound and technetium-99m SPECT-CT scans. Sensitivity, specificity, predictive values, and accuracy of 4D CT were evaluated. Nineteen patients (16 women and 3 men) were included with a mean age of 66 years (range, 39-80 years). Mean preoperative parathyroid hormone level was 108.5 pg/mL (range, 59.3-220.9 pg/mL), and mean weight of the excised gland was 350 mg (range, 83-797 mg). 4D CT sensitivity and specificity for localization to the patient's correct side of the neck were 84...
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