Background: Minimally invasive parathyroidectomy is the treatment of choice for single-gland primary hyperparathyroidism. However, the exact location of the abnormal gland has to be established. Sestamibi scintigraphy, computed tomography and ultrasound (US) are commonly used modalities. We describe our experience in a non-academic center with surgeon-performed US (S-US) of the neck as preoperative localization study in patients with primary hyperparathyroidism (PHPT). Methods: Patients with a biochemically proven diagnosis of PHPT and preoperative S-US were included. Data were recorded prospectively. Perioperative gland location was compared to the preoperative S-US to determine sensitivity, specificity and accuracy rates. Results: Two of the 50 patients who underwent S-US were not subjected to surgery. In 85% of the patients analyzed by S-US, the appropriate abnormal gland(s) were identified. In 11%, no gland was identified, but abnormal glands were found during surgery. Sensitivity of S-US in our hospital is 85%, with a positive predictive value of 97%. Conclusions: We achieved a satisfactory sensitivity rate. S-US provides anatomic information to the surgeon which enables a more detailed operation planning, and it is a valuable diagnostic modality for patients with PHPT in our opinion. We hope that our data encourage other centers to implement this technique as well.

Sitges-Serra A, Bergenfelz A: Clinical update: sporadic primary hyperparathyroidism. Lancet 2007;370:468–470.
Lee JA, Inabnet WB 3rd: The surgeon’s armamentarium to the surgical treatment of primary hyperparathyroidism. J Surg Oncol 2005;89:130–135.
Ruda JM, Hollenbeak CS, Stack BC Jr: A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg 2005;132:359–372.
Bergenfelz A, Kanngiesser V, Zielke A, Nies C, Rothmund M: Conventional bilateral cervical exploration versus open minimally invasive parathyroidectomy under local anaesthesia for primary hyperparathyroidism. Br J Surg 2005;92:190–197.
Bergenfelz A, Lindblom P, Tibblin S, Westerdahl J: Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial. Ann Surg 2002;236:543–551.
Udelsman R: Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 2002;235:665–670, discussion 670–662.
Smit PC, Borel Rinkes IH, van Dalen A, van Vroonhoven TJ: Direct, minimally invasive adenomectomy for primary hyperparathyroidism: an alternative to conventional neck exploration? Ann Surg 2000;231:559–565.
Russell CF, Dolan SJ, Laird JD: Randomized clinical trial comparing scan-directed unilateral versus bilateral cervical exploration for primary hyperparathyroidism due to solitary adenoma. Br J Surg 2006;93:418–421.
Sharma J, Mazzaglia P, Milas M, Berber E, Schuster DM, Halkar R, Siperstein A, Weber CJ: Radionuclide imaging for hyperparathyroidism (HPT): which is the best technetium-99m sestamibi modality? Surgery 2006;140:856–863, discussion 863–865.
Chapuis Y, Fulla Y, Bonnichon P, Tarla E, Abboud B, Pitre J, Richard B: Values of ultrasonography, sestamibi scintigraphy, and intraoperative measurement of 1–84 PTH for unilateral neck exploration of primary hyperparathyroidism. World J Surg 1996;20:835–839, discussion 839–840.
Siperstein A, Berber E, Barbosa GF, Tsinberg M, Greene AB, Mitchell J, Milas M: Predicting the success of limited exploration for primary hyperparathyroidism using ultrasound, sestamibi, and intraoperative parathyroid hormone: analysis of 1,158 cases. Ann Surg 2008;248:420–428.
Harari A, Zarnegar R, Lee J, Kazam E, Inabnet WB 3rd, Fahey TJ 3rd: Computed tomography can guide focused exploration in select patients with primary hyperparathyroidism and negative sestamibi scanning. Surgery 2008;144:970–976, discussion 976–979.
Hindie E, Ugur O, Fuster D, O’Doherty M, Grassetto G, Urena P, Kettle A, Gulec SA, Pons F, Rubello D: 2009 EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging 2009;36:1201–1216.
Wakamatsu H, Noguchi S, Yamashita H, Yamashita H, Tamura S, Jinnouchi S, Nagamachi S, Futami S: Technetium-99m tetrofosmin for parathyroid scintigraphy: a direct comparison with 99mTc-MIBI, 201Tl, MRI and US. Eur J Nucl Med 2001;28:1817–1827.
Wakamatsu H, Noguchi S, Yamashita H, Yamashita H, Tamura S, Jinnouchi S, Nagamachi S, Futami S: Parathyroid scintigraphy with 99mTc-MIBI and 123I subtraction: a comparison with magnetic resonance imaging and ultrasonography. Nucl Med Commun 2003;24:755–762.
Reeder SB, Desser TS, Weigel RJ, Jeffrey RB: Sonography in primary hyperparathyroidism: review with emphasis on scanning technique. J Ultrasound Med 2002;21:539–552, quiz 553–534.
Abboud B, Sleilaty G, Rabaa L, Daher R, Abou Zeid H, Jabbour H, Hachem K, Smayra T: Ultrasonography: highly accuracy technique for preoperative localization of parathyroid adenoma. Laryngoscope 2008;118:1574–1578.
Van Husen R, Kim LT: Accuracy of surgeon-performed ultrasound in parathyroid localization. World J Surg 2004;28:1122–1126.
Solorzano CC, Carneiro-Pla DM, Irvin GL 3rd: Surgeon-performed ultrasonography as the initial and only localizing study in sporadic primary hyperparathyroidism. J Am Coll Surg 2006;202:18–24.
Milas M, Stephen A, Berber E, Wagner K, Miskulin J, Siperstein A: Ultrasonography for the endocrine surgeon: a valuable clinical tool that enhances diagnostic and therapeutic outcomes. Surgery 2005;138:1193–1200, discussion 1200–1191.
Lindelius A, Torngren S, Pettersson H, Adami J: Role of surgeon-performed ultrasound on further management of patients with acute abdominal pain: a randomised controlled clinical trial. Emerg Med J 2009;26:561–566.
Jabiev AA, Ikeda MH, Reis IM, Solorzano CC, Lew JI: Surgeon-performed ultrasound can predict differentiated thyroid cancer in patients with solitary thyroid nodules. Ann Surg Oncol 2009;16:3140–3145.
Copeland DR, Cosper GH, McMahon LE, Boneti C, Little DC, Dassinger MS, Kokoska ER, Jackson RJ, Smith SD: Return of the surgeon in the diagnosis of pyloric stenosis. J Pediatr Surg 2009;44:1189–1192, discussion 1192.
Haber RS, Kim CK, Inabnet WB: Ultrasonography for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism: comparison with 99mtechnetium sestamibi scintigraphy. Clin Endocrinol (Oxf) 2002;57:241–249.
Purcell GP, Dirbas FM, Jeffrey RB, Lane MJ, Desser T, McDougall IR, Weigel RJ: Parathyroid localization with high-resolution ultrasound and technetium Tc 99m sestamibi. Arch Surg 1999;134:824–828, discussion 828–830.
Yeh MW, Barraclough BM, Sidhu SB, Sywak MS, Barraclough BH, Delbridge LW: Two hundred consecutive parathyroid ultrasound studies by a single clinician: the impact of experience. Endocr Pract 2006;12:257–263.
Molinari AS, Irvin GL 3rd, Deriso GT, Bott L: Incidence of multiglandular disease in primary hyperparathyroidism determined by parathyroid hormone secretion. Surgery 1996;120:934–936, discussion 936–937.
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