title: Ultrasound for localization in primary hyperparathyroidism.
abstract: OBJECTIVE
  To evaluate the capability of ultrasound for preoperative localization in primary hyperparathyroidism.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Multi-institutional Midwest Head and Neck Cancer Consortium.
  
  
  METHODS
  Two hundred twenty patients who underwent preoperative localization and had parathyroid surgery were evaluated. The findings of preoperative localization studies were correlated with surgical findings.
  
  
  RESULTS
  Preoperative ultrasonography, sestamibi scintigraphy, or both were obtained in 77%, 93%, and 69% of the patients, respectively. Preoperative ultrasonography and sestamibi scintigraphy localized an abnormality in 71% and 79% of patients, respectively. At the time of surgery, the localization by ultrasound was accurate in 82%. The accuracy of localization was similar for sestamibi scintigraphy (85%). In patients with inaccurate ultrasound localization, the sestamibi scintigraphy correctly identified the site of disease in only 45%. In patients with a nonlocalizing ultrasound, sestamibi scintigraphy was able to localize disease in only 47%, with 2 being in the mediastinum.
  
  
  CONCLUSIONS
  Ultrasonography is an acceptable initial localization study for patients with primary hyperparathyroidism. In patients with nonlocalizing ultrasound, sestamibi scintigraphy should be obtained, but can be expected to detect an abnormality in less than 50% of patients.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Nebraska, Omaha, Nebraska 68198, USA. rbsmith@unmc.edu
authors.forename: Russell B
authors.initials: RB
authors.lastname: Smith
authors.forename: Maria
authors.initials: M
authors.lastname: Evasovich
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Girod
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Jorgensen
authors.forename: William M
authors.initials: WM
authors.lastname: Lydiatt
authors.forename: Nitin A
authors.initials: NA
authors.lastname: Pagedar
authors.forename: Willam C
authors.initials: WC
authors.lastname: Spanos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D015899:Tomography, Emission-Computed, Single-Photon; D014463:Ultrasonography; D014481:United States
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
keywords: hyperparathyroidism; localization; ultrasonography