title: ROLE OF IMAGING TESTS FOR PREOPERATIVE LOCATION OF PATHOLOGIC PARATHYROID TISSUE IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM.
abstract: OBJECTIVE
  Primary hyperparathyroidism (PHPT) can be cured by parathyroidectomy, and the preoperative location of enlarged pathologic parathyroid glands is determined by imaging studies, especially cervical ultrasonography and scintigraphy scanning. The aim of this retrospective study was to evaluate the use of preoperative cervical ultrasonography and/or parathyroid scintigraphy in locating pathologic parathyroid tissue in a group of patients with PHPT followed in the same endocrine center.
  
  
  METHODS
  We examined the records of 61 patients who had undergone parathyroidectomy for PHPT following (99m)Tc-sestamibi scintigraphy scan and/or cervical ultrasonography. Scintigraphic and ultrasonographic findings were compared to histopathologic results of the surgical specimens.
  
  
  RESULTS
  Ultrasonography detected enlarged parathyroid glands in 87% (48/55) of patients with PHPT and (99m)Tc-sestamibi scintigraphy in 79% (37/47) of the cases. Ultrasonography was able to correctly predict the surgical findings in 75% (41/55) of patients and scintigraphy in 72% (34/47). Of 7 patients who had negative ultrasonography, scintigraphy correctly predicted the surgical results in 2 (29%). Of 10 patients who had negative scintigraphy, ultrasonography correctly predicted the surgical results in 4 (40%). When we analyzed only patients with solitary eutopic parathyroid adenomas, the predictive positive values of ultrasonography and scintigraphy were 90% and 86%, respectively.
  
  
  CONCLUSIONS
  Cervical ultrasonography had a higher likelihood of a correct positive test and a greater predictive positive value for solitary adenoma compared to (99m)Tc-sestamibi and should be used as the first diagnostic tool for preoperative localization of affected parathyroid glands in PHPT.
  
  
  BACKGROUND
  Ca = calcium IEDE = Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione PHPT = primary hyperparathyroidism PTH = parathyroid hormone.
authors.forename: Maria Caroline Alves
authors.initials: MC
authors.lastname: Coelho
authors.forename: Nathalie Anne
authors.initials: NA
authors.lastname: de Oliveira E Silva de Morais
authors.forename: Andrea Cristiani
authors.initials: AC
authors.lastname: Beuren
authors.forename: Cristiane Bertolino
authors.initials: CB
authors.lastname: Lopes
authors.forename: Camila Vicente
authors.initials: CV
authors.lastname: Santos
authors.forename: Joyce
authors.initials: J
authors.lastname: Cantoni
authors.forename: Leonardo Vieira
authors.initials: LV
authors.lastname: Neto
authors.forename: Maurício Barbosa
authors.initials: MB
authors.lastname: Lima
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D000368:Aged; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D006965:Hyperplasia / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging*; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D016105:Parathyroidectomy; D011300:Preoperative Care / Q000379:methods; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D014463:Ultrasonography
chemical_list: D017256:Technetium Tc 99m Sestamibi