The role of ultrasonography in parathyroid surgery.

OBJECTIVE To assess the role of high-resolution ultrasonography in the preoperative evaluation of patients with hyperparathyroidism. DESIGN Retrospective cohort. SETTING Tertiary care university hospital. PATIENTS Three hundred seventeen patients with hyperparathyroidism who underwent preoperative assessment with ultrasonography and/or sestamibi scan and surgical treatment between October 2003 and October 2006. MAIN OUTCOME MEASURES Descriptive statistics of localization imaging studies and detection of concomitant thyroid disease in patients presenting with hyperparathyroidism. RESULTS Ultrasonography correctly localized the parathyroid adenoma(s) in 148 (69.4%) of the 229 patients with these lesions. Sestamibi scans correctly localized the parathyroid adenoma(s) in 133 (58.1%) of the 229 patients. The agreement between the 2 imaging procedures was moderate (kappa = 0.23; 95% confidence interval, 0.12-0.36). Of 317 patients with hyperparathyroidism, 96 (30.3%) had clinically significant concomitant thyroid disease requiring partial or total thyroidectomy. Histopathologic examination revealed benign thyroid disease in 80 (83.0%) of the 96 patients and thyroid carcinoma in 16 (16.6%). CONCLUSION Ultrasonography is a useful tool in the preoperative evaluation of patients with hyperparathyroidism both for localization of parathyroid adenomas and for the diagnosis of concomitant thyroid disease.