Surgeon-performed ultrasound in primary hyperparathyroidism: a prospective study of 204 consecutive patients

A prospective study was conducted to assess the value of surgeon-performed ultrasound (SUS) in primary hyperparathyroidism. A total of 204 consecutive patients were studied prospectively with surgeon performed neck ultrasound. The results were compared with sestamibi nuclear scintigraphy (SNS) and radiologist-performed ultrasound (RUS) and correlated with the operative findings. SUS was true positive in 173 of 204 (85%), false positive in two (1%), false negative in 23 (11%), and true negative in six (2.5%) in patients, where the gland was inaccessible by US (sensitivity 88%, PPV 98%). SNS was true positive in 126 of 188 (67%), false positive in 3%, and false negative in 30% (sensitivity 69%, PPV 95%). RUS was true positive in 57 of 139 (40%), false positive in 5%, false negative in 52% and true negative in 3% (sensitivity 43%, PPV 89%). Comparing correct localization with incorrect localization by the Fisher’s exact test, SUS was superior to SNS (p < 0.0001) and to RUS (p < 0.0001). 116 patients had bilateral neck exploration and 88 had open focused minimally invasive surgery. Five percent had multigland disease and 97% were cured after one operation. SUS was the only imaging modality in 16 patients and was sufficiently convincing to allow minimally invasive parathyroidectomy in eight. Surgeons treating hyperparathyroidism should find SUS a valuable tool. In our experience, SUS was more accurate than RUS whose costeffectiveness is questionable