To Establish the True Positive Percentage of Cases Where Ultrasound Detected Nodules in Sestamibi Negative Cases of Hyperparathyroidism. Retrospective Data from A Single Institution”

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To evaluate the value addition of ultrasound, over sestamibi scan in patients with hyperparathyroidism. To establish the percentage of cases where ultrasound detected nodules in sestamibi negative cases of hyperparathyroidism. Retrospective study from year 2013 to 2017. A total of 250 patients of Hyperparathyroidism who had both ultrasound and Sestamibi scan for parathyroid localization and were operated at our institution were included. Ultrasound localized parathyroid as a hypoechoic ovoid nodule with arc of vascularity. Diagnostic findings were recorded. Among them 175 patients (70%) were positive on both Sestamibi Scan and Ultrasound and 65 patients (26%) were Sestamibi negative and were detected on ultrasound. Remaining 10 patients were negative on both ultrasound and Sestamibi. Of which 5 patients (2%) had Methionine PET & 5 patients (2%) had no further imaging done. Of the 250 patients,175 patients (70%) were positive on both Sestamibi Scan & Ultrasound and 65 patients (26%) were Sestamibi negative & were positive on ultrasound only. Remaining 10 (4%) patients were positive on Sestamibi, but negative on ultrasound. Of which in 5 patients (2%) the nodules were located in the mediastinum and 5 (2%) patients the nodules were located in neck. Of the nodules localized on both Sestamibi and ultrasound 173 patients (98.8%) were true positive at Surgery. Of the nodules localized only on ultrasound 61 patients (93.8%) were true positive at surgery. Ultrasound Detected Nodules in Sestamibi Negative Cases in 26% Cases and of Which True Positive at Surgery Were 24.4%. Ultrasound finds true positive parathyroid nodules in significant number of Sestamibi Negative cases (24.4 % in our study) and finds additional nodules in cases where sestamibi showed only one nodule which changes the plan of surgery and preoperative counselling of patient. It gives precise localization and size of the nodule(s).