title: [Comparison among ecography, scintigraphy and surgery in the localization of parathyroid glands in uremic patients undergoing parathyroidectomy].
abstract: BACKGROUND
  Sensitivity and specificity of the most widely employed techniques of parathyroid glands localization, namely echography and scintigraphy, are mostly obtained with short-term follow-up data and do not underline the existence of a methodological problem. As a matter of fact, both methods identify only pathological glands, with no "normal" results; therefore "true negatives" cannot be obtained. Aim of our study was to compare, by means of a statistically appropriate approach, the results of echography, scintigraphy and surgery with the data obtained after a mid term follow-up period, enabling us to discover all parathyroid glands.
  
  
  METHODS
  Twenty six consecutive dialysis patients (14M/12F; age 50+/-12 years) underwent echography and scintigraphy immediately before a total parathyroidectomy with autotransplantation and were followed-up for 6 months to recognize all the existing glands (PTH levels and scintigraphy).
  
  
  RESULTS
  Total identified glands were: 73 by scintigraphy, 86 by echography, 99 by surgery and 103 by follow-up data. The concordance indexes (K0) between the number of glands effectively present in the individual patient (follow-up data) and those identified with each method were rather low with scintigraphy (0.071) and echography (0.218), and acceptable (0.578) with surgery. The number of patients correctly classified was: 9/26 (34,6%) with scintigraphy, 13/26 (50%) with echography and 22/26 (85%) with surgery. Finally, the number of wrongly identified glands (from zero to three) in each patient was similar with scintigraphy (65,4%) and echography (50%) and significantly better with surgery (15,6%; p<0.01).
  
  
  CONCLUSIONS
  The most reliable technique to identify parathyroid glands in uremic subjects is surgery, nonetheless a meticulous clinical follow-up is necessary to recognize all of them.
authors.affiliation: Cattedra di Nefrologia, Università di Roma La Sapienza, Roma, Italia. sandro.mazzaferro@uniroma1.it
authors.forename: S
authors.initials: S
authors.lastname: Mazzaferro
authors.forename: G
authors.initials: G
authors.lastname: Matera
authors.forename: G
authors.initials: G
authors.lastname: Barresi
authors.forename: E
authors.initials: E
authors.lastname: Mancini
authors.forename: C
authors.initials: C
authors.lastname: Conte
authors.forename: G
authors.initials: G
authors.lastname: Otranto
authors.forename: F
authors.initials: F
authors.lastname: Taggi
authors.forename: S
authors.initials: S
authors.lastname: Gallina
authors.forename: F
authors.initials: F
authors.lastname: Gossetti
authors.forename: L
authors.initials: L
authors.lastname: Montemurro
authors.forename: D
authors.initials: D
authors.lastname: Proposito
authors.forename: M
authors.initials: M
authors.lastname: Carboni
mesh_terms: D000328:Adult; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000601:surgery*; D016105:Parathyroidectomy; D011877:Radionuclide Imaging; D013670:Sodium Pertechnetate Tc 99m; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors; D014463:Ultrasonography; D014511:Uremia / Q000150:complications*
chemical_list: D017256:Technetium Tc 99m Sestamibi; D013670:Sodium Pertechnetate Tc 99m