title: The utility of neck ultrasound and sestamibi scans in patients with secondary and tertiary hyperparathyroidism.
abstract: BACKGROUND
  Secondary hyperparathyroidism (SHPT) and tertiary hyperparathyroidism (THPT) are disease entities in patients with chronic kidney disease that are caused by parathyroid hyperplasia. The role of preoperative localization studies in patients undergoing parathyroidectomy for these conditions remains poorly defined.
  
  
  OBJECTIVE
  To evaluate the utility of surgeon-performed neck ultrasound (US) as well as sestamibi scans in the localization of parathyroid glands in patients with SHPT/THPT.
  
  
  METHODS
  A retrospective analysis of patients with SHPT/THPT who underwent parathyroidectomy at a single institution. Results of preoperative localization studies were compared to intraoperative findings.
  
  
  RESULTS
  One hundred and three patients underwent parathyroidectomy for SHPT/THPT. All patients underwent surgeon-performed neck US, while 92 (89%) underwent sestamibi scans. US failed to localize any of the parathyroids in 4 patients (3.8%), while sestamibi was negative in 11 (12%). Forty-seven ectopic glands were identified in 38 patients in whom sestamibi was performed. In five patients (13%), ectopic glands were identified by both modalities, by US only in 6 (16%), by sestamibi only in 8 (21%), and by neither study in 19 patients (50%). US showed new thyroid nodules in 19 patients (18.4 %), leading to lobectomy or thyroidectomy at the time of parathyroidectomy in 16 patients (15.5%). Pathology showed malignancy in 7 patients (6.8%).
  
  
  CONCLUSIONS
  US and MIBI offer little benefit in localizing ectopic glands and rarely change the conduct of a standard four-gland exploration. Although there was a benefit of US in the assessment of thyroid nodules, in only 8.7% of patients was sestamibi of benefit in identifying ectopic glands.
authors.affiliation: Department of Surgery, University of New Mexico, Albuquerque, NM, 87131, USA, eyaszk@yahoo.com.
authors.forename: Eyas
authors.initials: E
authors.lastname: Alkhalili
authors.forename: Yunus
authors.initials: Y
authors.lastname: Tasci
authors.forename: Erol
authors.initials: E
authors.lastname: Aksoy
authors.forename: Shamil
authors.initials: S
authors.lastname: Aliyev
authors.forename: Saranya
authors.initials: S
authors.lastname: Soundararajan
authors.forename: Eren
authors.initials: E
authors.lastname: Taskin
authors.forename: Allan
authors.initials: A
authors.lastname: Siperstein
authors.forename: Eren
authors.initials: E
authors.lastname: Berber
mesh_terms: D000328:Adult; D000368:Aged; D002828:Choristoma / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands; D016105:Parathyroidectomy; D011300:Preoperative Care; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000601:surgery; D013965:Thyroidectomy; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi