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Currently we offer unilateral neck exploration parathyroidectomy (UNE-PTX) only to patients with concordant ultrasound (USS) and nuclear medicine (NM) scans. Objective To compare potential cure rate from UNE-PTX to any patient with a single gland identified on USS with the current practice of dual concordant scans. Methods Case ascertainment; patients undergoing successful parathyroidectomy 2008 to 2018 by a single surgeon. Electronic patient records reviewed for imaging, operative records and pathology. Results 331 patients underwent surgery, 325 (98.2%) were cured. 288 (88.6%) had a single adenoma (PA), 37 (11.4%) had multi-gland disease (MGD) All patient had either USS or NM. 320 underwent US &amp; 315 NM scans. 309 patients had dual imaging. Sensitivity and specificity respectively were 72.3% &amp; 60.5% for US and 65.8% &amp; 62.2% for NM scans. USS accuracy was not influenced by the radiologist having prior access to NM report (kappa 0.4 vs 0.44). Concordant imaging; 141 patients. Of these 135 had a confirmed PA. 127 underwent UNE-PTX, 14 required bilateral neck exploration (BNE). US localised single gland; 217 patients. Of these 51(20.6%) had no uptake on NM scans. Based on US localisation alone if all 217 were offered UNE-PTX, 205/217 (94.5%) of patients with adenoma would be cured; 12 /217 (4.5%) with MGD recognisable at operation would have to be converted to BNE. Conclusion In our patients with a single adenoma using USS alone would have avoided 20.6% unnecessary BNE This has financial benefits to the health service as it avoids another investigation and hospital visit.

british journal of surgery

Can we justify using Parathyroid Ultrasound Scan as a sole preoperative localisation study for patients undergoing surgery for Primary Hyperparathyroidism?