Diagnostic value of parathyroid localization techniques in surgery for primary hyperparathyroidism

To determine the accuracy of imaging techniques for localization of nodular lesions of parathyroid glands. Seventy one patients were prospectively enrolled and underwent surgical examination for primary hyperparathyroidism. Ultrasonography (US), 201Tl/99mTc parathyroid subtraction scintigraphy and 99mTc MIBI scintigraphy were evaluated. The sensitivity and specificity for combined 201Tl/99mTc parathyroid subtraction scintigraphy and US for parathyroid adenomas were 72.27% and 89.22% respectively. The combination of 99mTc MIBI scintigraphy and US resulted in improved specificity (93.67%) and positive predictive value (80.39%). The accuracy of the localizing studies was lower for patients with hyperplasia. The combination of scintigraphy and US is the best approach for localization of nodules. In most cases, the two techniques are complementary.