{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T17:27:31Z","timestamp":1783618051742,"version":"3.55.0"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"<jats:sec id=\"ab-ooi240038-4\"><jats:title>Importance<\/jats:title><jats:p>Accurate preoperative localization is critical to success in targeted parathyroidectomy for primary hyperparathyroidism.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240038-5\"><jats:title>Objective<\/jats:title><jats:p>To determine if the association between the long axis of a parathyroid adenoma (PTA) candidate and strap musculature on sagittal ultrasonography (US) can be used to predict the embryologic origin of the gland.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240038-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This diagnostic study was performed using the Stanford Research Repository. Patients 18 years or older with primary hyperparathyroidism who underwent parathyroidectomy between January 2009 and October 2021 were considered. Additional inclusion criteria were having clear sagittal view of the adenoma candidate on US, confirmation of the gland of origin intraoperatively, and confirmation of hypercellular parathyroid on final pathology. Data were analyzed from October 2021 to June 2022.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240038-7\"><jats:title>Exposures<\/jats:title><jats:p>B-mode US and surgical parathyroidectomy.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240038-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The index test was using US to measure the angle between the long axis of an adenoma candidate and the strap musculature in the sagittal plane. This angle was used to test whether inferior and superior PTAs could be accurately assigned. The hypothesis was formulated prior to data collection.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240038-9\"><jats:title>Results<\/jats:title><jats:p>A total of 426 patients (mean [range] age, 61.1 [20-96] years; 316 [74.2%] female) with 442 adenomas met inclusion criteria. Of the 442 adenomas, 314 (71.0%) had measurable angles, of which 204 (46.2%) were assigned a superior origin, 238 (53.8%) were assigned an inferior origin, and 128 (29%) were indeterminate. Of the surgically identified superior PTAs, 144 (70.6%) had a definable angle, and of the surgically identified inferior PTAs, 170 (71.4%) had a definable angle. The receiver operating characteristic analysis found 94\u00b0 as the optimized angle for differentiating true negatives from true positives, with an overall sensitivity of 74% and specificity of 72%. This supported using 90\u00b0 as a break point for US review. True positives were considered superior adenomas with an angle greater than 90\u00b0; true negatives were inferior adenomas with an angle less than 90\u00b0. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of angulation analysis for determining PTA origin were 72.2% (95% CI, 64.9%-79.5%), 73.5% (95% CI, 66.9%-80.1%), 69.8% (95% CI, 62.5%-77.1%), 75.8% (95% CI, 69.3%-82.3%), and 72.9%, respectively. A subgroup analysis of 426 adenomas using the posterior carotid artery border on transverse US as a surrogate for predicting gland origin showed the following for sensitivity, specificity, positive predictive value, negative predictive value, and accuracy: 49.5% (95% CI, 42.6%-56.4%), 82.3% (95% CI, 77.3%-87.3%), 71.4% (95% CI, 63.9%-78.9%), 64.6% (95% CI, 59.1%-70.1%), and 66.9%, respectively.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240038-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This diagnostic study showed that PTA angulation on sagittal plane US can be used to predict gland of origin and guide surgery. The relationship between adenoma and posterior carotid artery border on transverse US can also be used to predict gland origin. These easy-to-apply US-based tests can be used in conjunction with other imaging modalities to guide targeted parathyroidectomy.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2024.1571","type":"journal-article","created":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T15:01:49Z","timestamp":1721314909000},"page":"756","source":"Crossref","is-referenced-by-count":5,"title":["Parathyroid Adenoma Orientation for Gland Embryologic Origin on Ultrasonography"],"prefix":"10.1001","volume":"150","author":[{"given":"Kyle R.","family":"Hannabass","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head & Neck Surgery, Stanford University School of Medicine, Stanford, California"},{"name":"Contra Costa ENT, Bass Medical Group, Walnut Creek, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaquin","family":"Austerlitz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head & Neck Surgery, Stanford University School of Medicine, Stanford, California"},{"name":"California University of Science and Medicine, Colton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia E.","family":"Noel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head & Neck Surgery, Stanford University School of Medicine, Stanford, California"},{"name":"Division of Otolaryngology\u2013Head & Neck Surgery, Santa Clara Valley Medical Center, Santa Clara, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa A.","family":"Orloff","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head & Neck Surgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"11","key":"ooi240038r1","doi-asserted-by":"publisher","first-page":"2315","DOI":"10.1002\/jbmr.4665","article-title":"Epidemiology, pathophysiology, and genetics of 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