Minimally invasive procedure for resection of a parathyroid adenoma: The role of preoperative high-resolution ultrasonography

Purpose. Solitary adenoma of the parathyroid is the major cause of primary hyperparathyroidism. Many centers advocate a minimally invasive surgical approach, wherein the surgeon explores only a localized area of the neck according to the preoperative imaging evaluation, and the adenoma is resected without histological sampling from the other parathyroid glands. The aim of this study was to evaluate the ability of high-resolution ultrasonography (US) to localize adenomas preoperatively and thereby aid in patient selection for minimal procedures. Methods. We reviewed the medical records of 77 consecutive patients who underwent resection of a parathyroid adenoma following ultrasonographic imaging between 2001 and 2002, and we assessed the accuracy of the preoperative localization of the adenomas as well as the efficacy of the minimally invasive procedure. Results. US correctly localized the adenoma to a specific quadrant of the neck in 87% of the cases and to a specific side of the neck in 94%. Overall, US sensitivity was 89%, with a positive predictive value of 98%. Its sensitivity was not reduced by the presence of nodular disease of the thyroid gland. Success rate for the minimal procedure was 98% (50/51 patients). Conclusions. US performed by a skilled operator is a reliable tool for adenoma localization prior to minimally invasive parathyroidectomy. If the US findings are inconclusive, a Tc-sestamibi scan should be used. If there is a high clinical suspicion of adenoma in the presence of negative imaging studies, bilateral neck exploration should be performed.