title: What is the added benefit of cervical ultrasound to ⁹⁹mTc-sestamibi scanning in primary hyperparathyroidism?
abstract: BACKGROUND
  Minimally invasive parathyroidectomy for primary hyperparathyroidism depends on accurate preoperative imaging, which is traditionally accomplished by (99m)Tc-sestamibi scanning. Cervical ultrasound is gaining in use, but it is unclear how much information it adds to the routine use of (99m)Tc-sestamibi scans.
  
  
  METHODS
  A prospectively maintained database of patients undergoing parathyroidectomy for primary hyperparathyroidism was queried, and the utility of cervical ultrasound in preoperative planning was analyzed.
  
  
  RESULTS
  Between July 2002 and November 2009, 310 patients with primary hyperparathyroidism underwent both (99m)Tc-sestamibi and ultrasound imaging. Ultrasound added new information to (99m)Tc-sestamibi in 43 patients (14%) by finding either the correct enlarged gland (n = 40, 88%) or additional enlarged glands (n = 5, 12%). Ultrasound correctly localized glands in 38 of 85 (45%) patients with a negative (99m)Tc-sestamibi, allowing for a minimally invasive parathyroidectomy in those patients. However, in the 206 patients (66%) who had a 1-gland positive (99m)Tc-sestamibi, ultrasound only added information for 8 patients (4%). When compared with radiology-performed ultrasound, surgeon-performed ultrasound was successful in localizing additional glands in 27 (15%) versus 17 patients (10%) (P < 0.001).
  
  
  CONCLUSIONS
  Ultrasound led to additional localization information in 14% of patients, although this benefit was less in patients with a clearly positive 1-gland (99m)Tc-sestamibi scan. Cervical ultrasound provides added benefit to (99m)Tc-sestamibi scanning in patients with primary hyperparathyroidism, but its greatest utility is when performed by a surgeon in patients with a negative (99m)Tc-sestamibi scan.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Joel T
authors.initials: JT
authors.lastname: Adler
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
authors.forename: Sarah
authors.initials: S
authors.lastname: Schaefer
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Sippel
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data*; D016105:Parathyroidectomy; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D014463:Ultrasonography
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi