title: The impact of surgeon-based ultrasonography for parathyroid disease on a British endocrine surgical practice.
abstract: BACKGROUND
  Surgeon-based ultrasonography (SUS) for parathyroid disease has not been widely adopted by British endocrine surgeons despite reports worldwide of accuracy in parathyroid localisation equivalent or superior to radiology-based ultrasonography (RUS). The aim of this study  was to determine whether SUS might benefit parathyroid surgical practice in a British endocrine unit.
  
  
  METHODS
  Following an audit to establish the accuracy of RUS and technetium sestamibi (MIBI) in 54 patients, the accuracy of parathyroid localisation by SUS and RUS was compared prospectively  with operative findings in 65 patients undergoing surgery for primary hyperparathyroidism (pHPT).
  
  
  RESULTS
  The sensitivity of RUS (40%) was below and MIBI (57%) was within the range of published results in the audit phase. The sensitivity (64%), negative predictive value (86%) and accuracy  (86%) of SUS were significantly greater than RUS (37%, 77% and 78% respectively). SUS significantly increased the concordance of parathyroid localisation with MIBI (58% versus 32% with RUS).
  
  
  CONCLUSIONS
  SUS improves parathyroid localisation in a British endocrine surgical practice. It  is a useful adjunct to parathyroid practice, particularly in centres without a dedicated parathyroid radiologist, and enables more patients with pHPT to benefit from minimally invasive surgery.
authors.affiliation: Royal Victoria Infirmary, Newcastle upon Tyne, UK. sebastianaspinall@yahoo.co.uk
authors.forename: S R
authors.initials: SR
authors.lastname: Aspinall
authors.forename: S
authors.initials: S
authors.lastname: Nicholson
authors.forename: R D
authors.initials: RD
authors.lastname: Bliss
authors.forename: T W J
authors.initials: TW
authors.lastname: Lennard
mesh_terms: D004704:Endocrinology / Q000592:standards*; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D008485:Medical Audit; D010279:Parathyroid Diseases / Q000601:surgery*; D016105:Parathyroidectomy / Q000592:standards*; D011364:Professional Practice; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000592:standards*; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D018084:Ultrasonography, Interventional / Q000592:standards*
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi