Department of Surgery, Division of Breast and Endocrine Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Am Surg. 2023 Feb;89(2):277-279. doi: 10.1177/00031348211023440. Epub 2021 May 31.
Attempts at preoperative localization of abnormal parathyroid gland(s) in primary hyperparathyroidism (pHPT) can be performed with a variety of modalities. Study utilization is surgeon-specific with highly variable opinions in parathyroid surgery. As more people are diagnosed with pHPT, the complexity of the disease has given rise to variation in management. This heterogeneity raises the question of the true clinical practice of imaging among individual endocrine surgeons.
To better understand the preoperative parathyroid imaging practices of endocrine surgeons, an email-based survey was disseminated to the program directors of 22 American Association of Endocrine Surgeons fellowship programs querying them on their initial diagnostic test of choice for pHPT. Clinical support team members from each respective program were subsequently contacted and answers were compared.
Sixty-eight percent (15/22) of clinical team members recommended either an additional (12/15) or different imaging test (3/15) than what was recommended by their institution's endocrine surgeon. The most common initial imaging test that was repeated by both the endocrine surgeon and clinical team member was neck ultrasound; 33% of clinical team members (7/22) responded concordantly to their surgeon with ultrasound as the initial recommendation.
Significant variability exists in the preoperative approach to patients with hyperparathyroidism. Here, we demonstrate that inconsistency in preoperative imaging recommendations even extends to within an individual surgeon's practice based on the impact of the clinical support team, highlighting the role for improved clinical protocols within an institution's clinical team.
在原发性甲状旁腺功能亢进症（pHPT）中，可通过多种方式尝试对异常甲状旁腺（s）进行术前定位。研究的利用情况因外科医生而异，甲状旁腺手术的意见高度不一致。随着越来越多的人被诊断出 pHPT，该疾病的复杂性导致了管理方式的变化。这种异质性引发了一个问题，即个体内分泌外科医生的影像学真正的临床实践是什么。
为了更好地了解内分泌外科医生的术前甲状旁腺影像学实践，我们向 22 个美国内分泌外科学会研究员计划的主任发送了基于电子邮件的调查，询问他们对 pHPT 的初始诊断测试选择。随后联系了每个项目的临床支持团队成员，并比较了他们的答案。
68%（15/22）的临床团队成员建议进行额外的（12/15）或不同的影像学检查（3/15），而不是他们所在机构内分泌外科医生推荐的检查。内分泌外科医生和临床团队成员都重复进行的最常见的初始影像学检查是颈部超声；33%的临床团队成员（7/22）的回应与他们的外科医生一致，将超声作为初始推荐。
在治疗甲状旁腺功能亢进症患者的术前方法中存在很大的差异。在这里，我们证明即使在单个外科医生的实践中，术前影像学建议的不一致性甚至会扩展到临床支持团队的影响，这突出了在机构的临床团队中改进临床方案的重要性。
