Detection of parathyroid adenoma in patients with primary hyperparathyroidism: the use of office-based ultrasound in preoperative localization.

Background: The purpose of this investigation is to show that preoperative localization of the parathyroid gland using office-based ultrasound (US) and Tc-99m sestamibi scan is superior to all other approaches in detecting a parathyroid adenoma.

Methods: We performed a retrospective analysis of 43 patients who underwent parathyroidectomy for primary hyperparathyroidism. All patients underwent office-based US and sestamibi scintigraphy. Upon completion of the localization studies, a plan for focused or full operation was determined.

Results: In 42 of 43 patients, office-based US performed by a surgeon and sestamibi scintigraphy successfully detected the location of a parathyroid abnormality (42/43 cases, sensitivity = 98%, P < .05 =.0001). Office-based US localized the abnormal gland to the specific side (right/left) in 36 of 43 cases (84%). Sestamibi alone localized to the specific side in 29 of 43 cases (67%) for a statistically significant difference (P = .03). US localized the abnormal gland to the specific quadrant (34/43 cases [79%] sensitivity versus 23/43 cases [53%] sensitivity using sestamibi scan alone to localize to the specific quadrant, P = .03).

Conclusion: It is clear that the combined modalities of office-based US and sestamibi scintigraphy in preoperative localization have a high success rate and should be considered in parathyroid surgery.