Effectiveness of "office"-based, ultrasound-guided differential jugular venous sampling (DJVS) of parathormone in patients with primary hyperparathyroidism

Background. Pre-operative localization is the first step for focused parathyroidectomy. Surgeon-performed ultrasonography (SUS) is used often as a single method of localization; however, when equivocal, sestainibi (MIBI) scan is still indicated. Intra-operative differential jugular venous sampling (DJVS) is positive in 71-80% of patients. The Purpose of this study is to evaluate the effectiveness of office based DJVS as the next method for localization when SUS is equivocal. Methods. Twenty-one patients with an equivocal SUS underwent office-based, SUS-guided DJVS. The samples were collected from the most inferior portion of each internal jugular vein and sent for standard parathormone (PTH) measurement. The side of the neck with the highest value of serum PTH was the initial side of exploration. DJVS lateralization was correlated retrospectively with operative findings. Results. In 17 of 21 (81%) patients, DJVS was correct in indicating the side of the abnormal gland. DJVS was incorrect in 2 and negative in 2 other patients. Bilateral neck explorations were performed in only 6 of 21 patients because of either multiglandular disease (3 patients), concomitant thyroidectomy (2 patients), or surgeon's judgment (1 patient). There were no complications from DJVS, and all patients became eucalcemic. Conclusion. Office based DJVS is accurate and may eliminate the need for MIBI in patients with equivocal SUS. This simple technique can shorten the pre-operative evaluation of sporadic primary hyperparathyroidism. (Surgery 2009; 146:1014-20.)