title: Case series of targeted parathyroidectomy with surgeon-performed ultrasonography as the only preoperative imaging study.
abstract: BACKGROUND
  Targeted parathyroidectomy for treatment of sporadic primary hyperparathyroidism (SPHPT) has become the preferred approach in many centers. Therefore, preoperative localization studies are increasingly important. Although surgeon-performed ultrasonography (SUS) is equivalent to sestamibi scanning (MIBI), many surgeons still obtain either a MIBI or both studies before cervical exploration. The goal of this study was to demonstrate the feasibility of targeted parathyroidectomy guided by intraoperative PTH monitoring (IPM) based on SUS localization alone.
  
  
  METHODS
  We studied 136 consecutive patients with SPHPT undergoing parathyroidectomy guided by IPM. Ninety-six (71%) patients had only SUS, whereas 40 (29%) also had a negative MIBI (total n = 136). Pre-, intra- and postoperative data were analyzed to evaluate SUS accuracy in localizing abnormal glands.
  
  
  RESULTS
  SUS correctly identified ≥ 1 abnormal gland in 90% (123/136) of the patients. Sensitivity and overall accuracy of SUS was 87% and 88%, respectively. Operative success was 99% with multiglandular disease incidence of 10%. Unilateral neck exploration was possible in the majority of patients.
  
  
  CONCLUSIONS
  Preoperative SUS is accurate in localizing hypersecreting glands; however, IPM remains paramount in determining the extent of neck dissection. The use of SUS as a single imaging method obviates the need for MIBI in most patients and decreases costs of parathyroidectomy guided by IPM.
authors.affiliation: Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Cindy
authors.initials: C
authors.lastname: Deutmeyer
authors.forename: Mike
authors.initials: M
authors.lastname: Weingarten
authors.forename: Megan
authors.initials: M
authors.lastname: Doyle
authors.forename: Denise
authors.initials: D
authors.lastname: Carneiro-Pla
mesh_terms: D005240:Feasibility Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000000981:diagnostic imaging* / Q000601:surgery*; D016343:Monitoring, Intraoperative; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D010281:Parathyroid Hormone