Two hundred consecutive parathyroid ultrasound studies by a single clinician: the impact of experience

To assess the ability of ultrasound studies, performed by an experienced clinician, to predict surgical findings and provide precise anatomic localization of abnormal parathyroid glands.

We retrospectively examined 200 consecutive parathyroid ultrasound studies performed by a single experienced clinician in our unit. All patients subsequently underwent parathyroidectomy, with histopathologic confirmation of abnormal parathyroid tissue. The correlation between the ultrasound and surgical findings was assessed.

Of the 200 study patients, 197 (98.5%) were cured of their disease at the initial operation. Ultrasound studies correctly predicted the surgical findings in 88% of patients, including 168 of 180 (93%) with single gland disease and 7 of 20 (35%) with multiple gland disease (MGD). In all cases in which a single adenoma was identified, precise information regarding its location relative to adjacent anatomic structures was provided. In 92% of these cases, anatomic details correlated closely with surgical findings. Ectopic and descended superior adenomas were most frequently missed. Patients with two nonlocalizing studies (scintigraphy and ultrasonography) had a >50% likelihood of having MGD.

In experienced hands, parathyroid ultrasonography is a highly sensitive technique that provides both localization of enlarged parathyroid glands and precise anatomic detail. Thus, in this study, focused parathyroidectomy was possible in 76.5% of patients. MGD remains difficult to diagnose preoperatively. Nonlocalizing studies should alert the surgeon to a high probability of MGD and prompt the performance of 4-gland exploration.