title: Diagnostic value of endoscopic ultrasonography for preoperative localization of parathyroid adenomas.
abstract: The most common cause of primary hyperparathyroidism (PHPT) is a single, sporadic parathyroid adenoma. Ultrasonography (US) and (99m)Technetium methoxyisobutylisonitrile ((99m)Tc-MIBI) scintigraphy are the imaging methods most widely used to localize parathyroid adenomas. The purpose of the present study was to determine the diagnostic value and accuracy of endoscopic ultrasonography (EUS) for localizing parathyroid adenoma compared with those of US and (99m)Tc-MIBI scintigraphy. Forty-seven patients with a PHPT diagnosis and who were recommended for surgery were enrolled in this study. An endoscopist who was blinded to the previous US and (99m)Tc-MIBI scintigraphy results performed the EUS in each patient. Thirty-nine female and eight male patients with PHPT were evaluated. The presence of adenoma was confirmed by subsequent postsurgical pathology results. One case was excluded because the histopathological evaluation was compatible with a lymph node, although the lesion was detected using three different imaging modalities preoperatively. The locations of the parathyroid adenomas were correctly documented by US in 39 patients (84.7 %) by (99m)Tc-MIBI scintigraphy in 35 (76.0 %), and by EUS in 44 (95.6 %) of 46 patients. EUS located all 31 adenomas detected previously with US and (99m)Tc-MIBI scintigraphy. EUS also successfully located three adenomas that could not be identified by US and (99m)Tc-MIBI scintigraphy. The positive predictive value and diagnostic accuracy of EUS, US, and (99m)Tc-MIBI were 97.7, 97.7, and 95.6 %; 88.6, 97.5, and 86.9 %; and 77.7, 97.2, 76.0 %, respectively. EUS was preferred as the second step imaging tool for detecting parathyroid adenomas that could not be localized by US and (99m)Tc-MIBI scintigraphy.
authors.affiliation: Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, No: 2, Bilkent Yolu, Ankara, Turkey, reyhanersoy@yahoo.com.tr.
authors.forename: Reyhan
authors.initials: R
authors.lastname: Ersoy
authors.forename: Osman
authors.initials: O
authors.lastname: Ersoy
authors.forename: Berna
authors.initials: B
authors.lastname: Evranos Ogmen
authors.forename: Sefika Burcak
authors.initials: SB
authors.lastname: Polat
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kilic
authors.forename: Nilufer
authors.initials: N
authors.lastname: Yildirim
authors.forename: Levent
authors.initials: L
authors.lastname: Ozturk
authors.forename: Bekir
authors.initials: B
authors.lastname: Cakir
mesh_terms: D000236:Adenoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D019160:Endosonography; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D055815:Young Adult
chemical_list: D017256:Technetium Tc 99m Sestamibi