title: Neck ultrasonography as preoperative localization of primary hyperparathyroidism with an additional role of detecting thyroid malignancy.
abstract: OBJECTIVE
  To evaluate and compare the diagnostic performances of high-resolution ultrasonography and (99m)Tc-sestamibi scintigraphy for the preoperative localization of abnormal parathyroid glands and to evaluate the ability of US for additional diagnostic roles in detecting thyroid malignancy in patients with pHPT.
  
  
  METHODS
  Preoperative localization images of 115 parathyroid adenomas from high-resolution ultrasonography (US) and (99m)Tc-sestamibi scintigraphy (SS) were studied from 105 patients, who had undergone parathyroidectomy. Sensitivity, accuracy, and positive predictive value were calculated for the identification of adenomas in lesions and patients for both US and SS, respectively, and US and SS diagnostic performances were compared using generalized estimating equation.
  
  
  RESULTS
  Preoperative imaging by both modalities localized 105 (93.8%) of the 112 parathyroid lesions confirmed at surgery and histology. Sensitivity, accuracy, and positive predictive value were 93.1% and 92.2%, 90.4% and 89.5%, and 96.9% and 96.9% by US and SS, respectively, without any statistically significant differences (P=0.796, 0.796, 0.879). US found incidental thyroid nodules in 47 patients (47/107, 43.9%), and 7 patients (7/107, 6.5%) were confirmed to have malignancy based on pathology results (all had papillary thyroid carcinoma).
  
  
  CONCLUSIONS
  Neck ultrasonography and (99m)Tc-sestamibi scintigraphy are complementary methods of the preoperative localization of parathyroid adenomas. Neck ultrasounds add an additional thyroid gland evaluation, and can be useful in the detection of incidental thyroid gland lesions, especially malignant nodules.
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea.
authors.forename: Joon Ho
authors.initials: JH
authors.lastname: Kwon
authors.forename: Eun-Kyung
authors.initials: EK
authors.lastname: Kim
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Lee
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Moon
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Kwak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D011300:Preoperative Care; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D017256:Technetium Tc 99m Sestamibi; D013964:Thyroid Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014463:Ultrasonography / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi