title: Pre-operative ultrasonography guiding minimal, selective surgical approach in primary hyperparathyroidism.
abstract: BACKGROUND
  The traditional surgical approach for the treatment of primary hyperparathyroidism (HPT) has been routine bilateral surgical exploration. Our aim was to evaluate pre-operative ultrasonography (U/S) in altering our practice to selective unilateral neck exploration.
  
  
  METHODS
  A retrospective study was conducted involving 53 patients who had parathyroidectomy over a 5-year period (1989-1994), 41 of whom with the diagnosis of HPT had pre-operative neck U/S.
  
  
  RESULTS
  Thirty-eight patients had a single adenoma, one had parathyroid cancer, and two had multiple adenomas. Thirty-six of 41 (88%) patients were true positives, two (5%) false positives, two (5%) false negatives and one (2%) was true negative. Based on the surgeon's personal preference and U/S results, 21/41 (51%) of patients had bilateral and 20/41 (49%) had unilateral neck exploration. All the 41 patients had resolution of the hypercalcemia postoperatively. Eighteen of 38 (47%) patients with a single adenoma had bilateral neck exploration and only in two patients was this necessary.
  
  
  CONCLUSIONS
  Patients undergoing parathyroid surgery for HPT should have preoperative U/S and, if a single enlarged parathyroid gland is found, unilateral U/S guided neck exploration is safe and economical. In all the other patients, bilateral exploration is the preferred approach.
authors.affiliation: Department of Surgery, Providence Hospital, Southfield, Michigan, USA.
authors.forename: O A
authors.initials: OA
authors.lastname: Preventza
authors.forename: S
authors.initials: S
authors.lastname: Yang
authors.forename: J J
authors.initials: JJ
authors.lastname: Karo
authors.forename: A
authors.initials: A
authors.lastname: Lobocki
authors.forename: V
authors.initials: V
authors.lastname: Mittal
authors.forename: D W
authors.initials: DW
authors.lastname: Sims
authors.forename: S
authors.initials: S
authors.lastname: Young
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D007839:Functional Laterality; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010282:Parathyroid Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014463:Ultrasonography