title: Preoperative ultrasound and nuclear medicine studies improve the accuracy in localization of adenoma in hyperparathyroidism.
abstract: OBJECTIVE
  Today, minimizing the operating time makes preoperative hyperparathyroid lesion localization more valuable and it is routinely performed through ultrasound (US) and/or nuclear imaging (NI). We evaluated the accuracy of US and NI, used separately or concurrently, in the preoperative identification and localization of hyperparathyroid lesions.
  
  
  METHODS
  Retrospectively, patients receiving a parathyroidectomy for primary hyperparathyroidism from January 1985 through August 2000 were reviewed. The demographics, operative characteristics, serum laboratories, pathology, and radiology results were evaluated.
  
  
  RESULTS
  A total of 226 operations were performed including 160 adenomas, 64 hyperplasia, and 2 carcinomas. For US the sensitivity was 67%, specificity 33%, and positive predictive value (PPV) 82%. For NI these values were 67%, 55%, and 86%, respectively. When either US or NI were positive, the results were 82%, 29%, and 85%, respectively. When both were positive, the results were 53%, 71%, and 90%, respectively. When both were positive, and had side concordance, the results were 53%, 100%, and 100%, respectively.
  
  
  CONCLUSIONS
  Positive NI correlated with an accurate pathologic location. Concordance of imaging tests increased specificity, PPV, and likelihood ratio. Negative localization on both imaging tests had a higher probability of being hyperplasia. Agreement of tests, especially when the side agrees, had a higher probability of adenoma.
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Whitson
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Broadie
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology*; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000473:pathology; D010282:Parathyroid Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging; D014463:Ultrasonography