Detection of parathyroid adenoma in patients with primary hyperparathyroidism: the use of office-based ultrasound in preoperative localization.
BACKGROUND
The purpose of this investigation is to show that preoperative localization of the parathyroid gland using office-based ultrasound (US) and Tc-99m sestamibi scan is superior to all other approaches in detecting a parathyroid adenoma.


METHODS
We performed a retrospective analysis of 43 patients who underwent parathyroidectomy for primary hyperparathyroidism. All patients underwent office-based US and sestamibi scintigraphy. Upon completion of the localization studies, a plan for focused or full operation was determined.


RESULTS
In 42 of 43 patients, office-based US performed by a surgeon and sestamibi scintigraphy successfully detected the location of a parathyroid abnormality (42/43 cases, sensitivity = 98%, P < .05 =.0001). Office-based US localized the abnormal gland to the specific side (right/left) in 36 of 43 cases (84%). Sestamibi alone localized to the specific side in 29 of 43 cases (67%) for a statistically significant difference (P = .03). US localized the abnormal gland to the specific quadrant (34/43 cases [79%] sensitivity versus 23/43 cases [53%] sensitivity using sestamibi scan alone to localize to the specific quadrant, P = .03).


CONCLUSIONS
It is clear that the combined modalities of office-based US and sestamibi scintigraphy in preoperative localization have a high success rate and should be considered in parathyroid surgery.
Berri
Richard N
RN
Department of Surgery, St John Hospital and Medical Center, 22151 Moross Road, PB 1 Suite 332, Detroit, MI 48236, USA. Richard.berri@stjohn.org
Lloyd
Larry R
LR
D000236:Adenoma / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging*; D016105:Parathyroidectomy; D011300:Preoperative Care; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D014463:Ultrasonography
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi