Accuracy of Surgeon-performed Ultrasound in Parathyroid Localization

Ultrasound is one of the preferred modalities for localization of abnormal parathyroids. Accuracy of ultrasound is technician-dependent. This study was undertaken to determine the accuracy of surgeon-performed ultrasound (SPU) for the localization of parathyroid tumors in comparison to radiology-performed ultrasound (RPU) and nuclear scintigraphy (NS). In this series 74 consecutive patients with untreated primary hyperparathyroidism underwent SPU at the initial clinic visit; 21 of these patients did not undergo surgery and are excluded from the analysis. Of the 53 patients remaining, RPU was obtained in 26, and 52 patients underwent NS. Directed parathyroidectomy was performed with use of the intraoperative parathyroid hormone assay (IOPTH). In all, 46 patients had a single adenoma as indicated by IOPTH and final pathology. Two patients had double gland disease, and 5 patients had multi-gland hyperplasia. The sensitivity of SPU was 82% and the specificity was 90% in detecting the diseased glands on the correct side (right versus left). The sensitivity for RPU was 42% and the specificity was 92% (n = 26). The sensitivity of NS was 44% and the specificity was 98% (n = 52). In only one case did RPU or NS detect a gland not found by SPU. SPU can be done with accuracy comparable to other ultrasound series in the literature, and it may be superior to RPU or NS in some institutions. It is important for surgeons to be aware of local institutional expertise when relying on RPU and NS during preoperative evaluation prior to directed parathyroidectomy.