title: Ultrasound based focused neck exploration for primary hyperparathyroidism.
abstract: OBJECTIVE
  We review our experience with focused neck exploration (FNE) based on ultrasound (USN) alone, in patients with primary hyperparathyroidism (PHP) and negative sestamibi scans (SES).
  
  
  METHODS
  124 patients with PHP were evaluated for FNE and studied with SES and USN. 53 patients (43%) had a negative SES. 49 of those patients (92%) were selected for FNE based on USN criteria of a single abnormal gland, .5 cm or greater, as determined by an experienced surgeon-sonographer.
  
  
  RESULTS
  40 of 49 patients (82%) selected on USN criteria alone underwent successful FNE. Of the 9 patients who required neck exploration 6 (12%) were incorrectly localized, 2 (4%) were found to have hyperplasia, and 1 (2%) was correctly localized but not found on the initial exploration. US had a 97.5% sensitivity and a 25% specificity as a diagnostic test for single adenomas, both within the 95% confidence interval. Of those glands successfully imaged by USN, image size correlated well with the measured size of the adenoma at path, on average within 0.40 cm (Standard deviation 0.30 cm).
  
  
  CONCLUSIONS
  We feel our data show that USN provides reliable information in patient selection for FNE. The literature supports SES as a more reliable study when positive for parathyroid adenoma, but false negative rates of 30-40% have been reported. Routine use of preoperative US by experienced surgeon-sonographers would result in more patients selected for FNE vs. routine neck exploration with expected benefits.
authors.affiliation: Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine Detroit, MI and OSF Surgical-Rockford Rockford, IL, USA. Electronic address: sbradley@med.wayne.edu.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Bradley
authors.affiliation: Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine Detroit, MI and OSF Surgical-Rockford Rockford, IL, USA.
authors.forename: Kathleen F
authors.initials: KF
authors.lastname: Knodle
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging*; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000209:etiology*; D010280:Parathyroid Glands / Q000000981:diagnostic imaging*; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging*; D018579:Patient Selection; D011300:Preoperative Care; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography
keywords: Focused neck exploration; Parathyroid adenoma; Primary hyperparathyroidism; Sestamibi scan; Ultrasound