title: Further evidence against the routine use of parathyroid ultrasonography prior to initial neck exploration for hyperparathyroidism.
abstract: The role of preoperative localization tests in patients undergoing initial neck exploration for hyperparathyroidism (HPT) is controversial. The use of parathyroid ultrasonography (US) in 46 patients (7 men, 39 women; mean age: 60 years) who underwent initial neck exploration for hypercalcemia and who had the diagnosis of HPT confirmed at surgery is reported. At surgery, a single adenoma was found in 40 patients and multiple hyperplastic glands in 6 patients. Of the 40 adenomas, only 22 (58%) were localized to the correct side by the preoperative US, and only 5 of 18 hyperplastic glands (28%) were correctly localized. The rates of false-positive and false-negative results were 10% and 46%, respectively. The sensitivity of parathyroid US was 54%, the specificity 90%, and the accuracy 70%. The low sensitivity and accuracy and the high rate of false-negative test results that were observed suggest that there is no role for the routine use of parathyroid US in patients undergoing initial neck exploration for HPT.
authors.affiliation: Department of Surgery, University of Cincinnati Medical Center, Ohio 45267-0558.
authors.forename: P O
authors.initials: PO
authors.lastname: Hasselgren
authors.forename: J P
authors.initials: JP
authors.lastname: Fidler
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000000981:diagnostic imaging; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000601:surgery*; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D011300:Preoperative Care; D012680:Sensitivity and Specificity; D014463:Ultrasonography