The Role of Surgeon-Performed Office and Preincision Ultrasounds in Localization of Parathyroid Adenomas in Primary Hyperparathyroidism

Objective: We studied the use of surgeon-performed office ultrasound (OU) and preincision ultrasound (PIU) in preoperatively localizing parathyroid adenomas in primary hyperparathyroidism (PHPT). Methods: A retrospective chart review was performed for patients with PHPT who underwent para-thyroidectomy between 2013 and 2015. The results of OU and PIU were recorded and compared with the final surgical pathology. Results: Of 348 patients with PHPT, 285 (81.9%) had single-lesion disease, 49 (14.1%) had double-lesion disease, and 14 (4.0%) had multigland disease with 3 or more lesions. For single-lesion disease, the overall sensitivity and specificity of OU to correctly lateralize the lesion were 64.2% and 91.2%, while those of PIU were 89.4% and 93.6%, respectively. The sensitivity and specificity of PIU were comparable to those of 4-dimensional computed tomography (87.1% and 90.7%, respectively) and 99mTc-sestamibi scintigraphy (70.4% and 95.9%, respectively). While the majority of PIU cases were preceded by other imaging studies, the accuracy in localizing lesions was not largely affected by the presence of prior computed tomography and/or 99mTc-sestamibi scintigraphy, as opposed to ultrasounds only. For detecting the presence of multigland disease, the sensitivity and specificity of OU were 26% and 92.2%, while those of PIU were 64.3% and 94.7%, respectively. Conclusion: Surgeon-performed OU and PIU are valuable tools in preoperatively localizing the para-thyroid adenoma in single-lesion disease, while their utility may be limited for double-lesion or mul-tigland disease. PIU in particular yields high accuracy in detecting parathyroid lesions in combination with other imaging modalities. (C) 2022 AACE. Published by Elsevier Inc. All rights reserved.