The Laryngoscope Lippincott Williams & Wilkins, Inc. © 2006 The American Laryngological, Rhinological and Otological Society, Inc. Parathyroid Adenoma Localization: Surgeon-Performed Ultrasound Versus Sestamibi David L. Steward, MD; Gregory P. Danielson, MD; Chad E. Afman, MD; Jeffrey A. Welge, PhD Objectives: Compare surgeon-performed ultra- sound versus sestamibi for preoperative parathy- roid adenoma localization. Study Design: Single- institutional cohort. Methods: One hundred six consecutive patients undergoing parathyroidectomy at an academic institution between 2004 to 2005 were included. Of those, 103 underwent both surgeon- performed ultrasound and sestamibi-Tc99m localiza- tion preoperatively. Primary outcome is sensitivity for adenoma localization to correct quadrant (right vs. left, superior vs. inferior). Results: Hypercalce- mia resolved in 97% of patients. Sensitivities for correct quadrant localization for ultrasound versus sestamibi were 87% versus 58% (P < .001). Specifici- ties were 95%. Positive and negative predictive values were 85% versus 78% and 96% versus 87%, respectively. Combined sensitivity was 93%. Sensitivities for correct side localization were 91% and 74% (P  .002). Conclu- sions: Ultrasound appears more sensitive than sesta- mibi for localization to correct quadrant or side when performed in-office by the author in this cohort. Key Words: Ultrasound, parathyroid, sestamibi, sensitivity, primary hyperparathyroidism, hypercalcemia, para- thyroidectomy, minimally invasive parathyroidectomy. Laryngoscope, 116:1380 –1384, 2006 INTRODUCTION Primary hyperparathyroidism is a common endocrine disorder that affects 1 in 700 people. The vast majority of patients with excess parathyroid hormone (PTH) secretion have solitary parathyroid adenomas. 1 Since the 1960s, when serum autoanalyzers were available to reliably di- agnose hyperparathyroidism, the gold standard for surgi- cal cure has been bilateral neck exploration and evalua- tion of all four glands. This technique has achieved cure rates of greater than 95%, with minimal morbidity and mortality (1%). 2 During the last decade, in an effort to reduce opera- tive time, provide better cosmesis, and reduce complica- tions (i.e., recurrent nerve damage and postoperative hy- pocalcemia), minimally invasive parathyroidectomy has been gaining popularity. This focused approach is possible because preoperative imaging can accurately identify the location of solitary parathyroid adenomas and allow the surgeon to perform a unilateral or focused exploration with similar rates of surgical cure, morbidity, and mortal- ity to bilateral neck exploration. 3 The most commonly used imaging techniques for pre- operative parathyroid adenoma localization include high- resolution sonography, computed tomography, magnetic resonance imaging, and radionucleotide scintigraphy. Currently, the most consistently accurate tests have been Technetium-99m-sestamibi scintigraphy (sensitivities of 54 –93%) and ultrasonography (sensitivities of 57–93%), traditionally performed and interpreted by radiologists. 4–8 In this study, we wanted to investigate surgeon- performed, in-office, high-resolution ultrasound in compari- son with sestamibi scanning for the preoperative localization of parathyroid adenomas. We hypothesize that in-office ul- trasound may be an effective localization adjunct for sur- geons performing focused parathyroidectomy because it pro- vides greater anatomic detail than radionuclide scans. MATERIALS AND METHODS Study Objective and Design The primary objective of this study is to review a single- institution cohort and compare the sensitivity of surgeon-performed, high-resolution ultrasound to dual-phase technetium 99m sestamibi for preoperative localization of parathyroid adenomas. Patients After receiving approval from the local institutional review board, Current Procedural Terminology codes 60500 and 60502 were used to identify patients from departmental databases who underwent parathyroidectomy by the senior author over the pe- From the Department of Otolaryngology–Head and Neck Surgery (D.L.S., C.E.A.) and Center for Biostatistical Services (J.A.W.), University of Cincinnati, Cincinnati, Ohio, U.S.A., and Division of Otolaryngology–Head and Neck Surgery, Department of Surgery (G.P.D.), University of Vermont, Burlington, Vermont, U.S.A. Editor’s Note: This Manuscript was accepted for publication March 13, 2006. Presented at the Middle Section Meeting of the Triological Society, January 2005. Send Correspondence to Dr. David L. Steward, 231 Albert Sabin Way, ML # 0528, University of Cincinnati Medical Center, Department of Otolaryngology–Head and Neck Surgery, Cincinnati, OH 45267-0528. E-mail: David.Steward@uc.edu DOI: 10.1097/01.mlg.0000227957.06529.22 Laryngoscope 116: August 2006 Steward et al.: Parathyroid Adenoma Localization 1380