{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T11:19:40Z","timestamp":1788261580908,"version":"build-2803163510"},"reference-count":37,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004196","name":"Odense Universitetshospital","doi-asserted-by":"publisher","award":["60.000 DKK"],"award-info":[{"award-number":["60.000 DKK"]}],"id":[{"id":"10.13039\/501100004196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n To evaluate the sensitivity of a stepwise preoperative imaging regimen for patients with primary hyperparathyroidism.<\/jats:p>\n <\/jats:sec>\n \n Study design<\/jats:title>\n Prospective cohort study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n A high\u2010volume tertiary referral center for parathyroidectomy.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Patients with primary hyperparathyroidism referred for parathyroidectomy underwent surgeon\u2010performed ultrasound as the primary preoperative imaging examination. The diagnostic confidence of the examiner on a scale from 0 to 3 determined whether additional imaging was acquired. If ultrasound identified an enlarged parathyroid gland with certainty (score 3), the patient was booked directly for surgery. If the confidence score was <3, the patient underwent either parathyroid scintigraphy or 18F\u2010choline PET\/CT. The gold standard was the intraoperative location of pathological parathyroid glands combined with biochemical cure \u22656 months after surgery. The primary endpoint was the sensitivity of the stepwise imaging regimen per patient, irrespective of the number of acquired imaging modalities. Secondary endpoints were the sensitivity per gland and the sensitivity of the imaging regimen if the cut\u2010off for additional imaging had been a confidence score of 1 or 2.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Upfront ultrasound spared 49 of 99 patients (49.5%) from additional imaging and correctly localized \u22651 pathological parathyroid gland in 98.0% of patients [95% CI 92.9\u201099.8]. The per\u2010gland sensitivity was 92.5% [95% CI 84.8\u20101.0]. When changing the cut\u2010off to a confidence score of 2, the per\u2010patient sensitivity remained 98.0% [95% CI 92.9\u201099.8].<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Our study demonstrates that a stepwise imaging regimen based on upfront ultrasound by an experienced examiner can substantially reduce the number of radiation\u2010based supplemental scans, while maintaining a high sensitivity.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ohn.70425","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T11:02:36Z","timestamp":1788260556000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Protocolled Implementation of Upfront Ultrasound, A Stepwise Pre\u2010Operative Imaging Regimen in Primary Hyperparathyroidism"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3207-2764","authenticated-orcid":false,"given":"Vanessa","family":"Dedeic","sequence":"first","affiliation":[{"name":"Research Unit for ORL \u2013 Head & Neck Surgery, and Audiology Odense University Hospital Odense Denmark"},{"name":"OPEN, Open Patient Data Explorative Network Odense University Hospital, Region of Southern Denmark Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6335-3303","authenticated-orcid":false,"given":"Oke","family":"Gerke","sequence":"additional","affiliation":[{"name":"Department of Clinical Research University of Southern Denmark Odense Denmark"},{"name":"Department of Nuclear Medicine Odense University Hospital Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7992-8490","authenticated-orcid":false,"given":"Mette","family":"Bay","sequence":"additional","affiliation":[{"name":"Research Unit for ORL \u2013 Head & Neck Surgery, and Audiology Odense University Hospital Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9770-3188","authenticated-orcid":false,"given":"Jes Sloth","family":"Mathiesen","sequence":"additional","affiliation":[{"name":"Research Unit for ORL \u2013 Head & Neck Surgery, and Audiology Odense University Hospital Odense Denmark"},{"name":"Department of Clinical Research University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9348-7078","authenticated-orcid":false,"given":"Marie","family":"Westergaard\u2010Nielsen","sequence":"additional","affiliation":[{"name":"Research Unit for ORL \u2013 Head & Neck Surgery, and Audiology Odense University Hospital Odense Denmark"},{"name":"Department of Clinical Research University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1907-8743","authenticated-orcid":false,"given":"Sys","family":"Vestergaard","sequence":"additional","affiliation":[{"name":"Department of Clinical Research University of Southern Denmark Odense Denmark"},{"name":"Department of Nuclear Medicine Odense University Hospital Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0122-0916","authenticated-orcid":false,"given":"Paw Christian","family":"Holdgaard","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine University Hospital of Southern Denmark, Lillebaelt Hospital Vejle Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8078-1908","authenticated-orcid":false,"given":"Viveque Egsgaard","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Research Unit for ORL \u2013 Head & Neck Surgery, and Audiology Odense University Hospital Odense Denmark"},{"name":"OPEN, Open Patient Data Explorative Network Odense University Hospital, Region of Southern Denmark Denmark"},{"name":"Department of Clinical Research University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2771-6127","authenticated-orcid":false,"given":"Sanne H\u00f8xbroe","family":"Michaelsen","sequence":"additional","affiliation":[{"name":"Research Unit for ORL \u2013 Head & Neck Surgery, and Audiology Odense University Hospital Odense Denmark"},{"name":"OPEN, Open Patient Data Explorative Network Odense University Hospital, Region of Southern Denmark 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