caa a22 4500 445333243 CHVBK 20180317142744.0 cr unu---uuuuu 170323e20110601xx s 000 0 eng 10.1245/s10434-010-1493-2 doi (NATIONALLICENCE)springer-10.1245/s10434-010-1493-2 Primary Hyperparathyroidism Patients with Positive Preoperative Sestamibi Scan and Negative Ultrasound Are More Likely to Have Posteriorly Located Upper Gland Adenomas (PLUGs) [Elektronische Daten] [Avital Harari, Elliot Mitmaker, Raymon Grogan, James Lee, Wen Shen, Jessica Gosnell, Orlo Clark, Quan-Yang Duh] Background: Standard preoperative imaging for primary hyperparathyroidism usually includes sestamibi scanning (MIBI) and ultrasound (US). In a subset of patients with a positive MIBI and a negative US, we hypothesize that the parathyroid adenomas are more likely to be located posteriorly in the neck, where anatomically they are more difficult to detect by US. Methods: We retrospectively reviewed the records of 661 patients treated for primary hyperparathyroidism between 2004 and 2009 at a tertiary referral center. We included patients who for their first operation had a MIBI that localized a single lesion in the neck and an US that found no parathyroid adenoma. We excluded patients with persistent or recurrent hyperparathyroidism, and patients with MIBIs that were negative, that had more than one positive focus, or that had foci outside of the neck. Sixty-six cases were included in the final analysis. Results: A total of 54 patients (83%) had a single adenoma, 4 (6%) had double adenomas, and 7 (11%) had hyperplasia. Thirty-three patients (51%) had a single upper gland adenoma; 19 of these (58%) were posteriorly located upper gland adenomas (PLUGs). PLUGs occurred more often on the right side than on the left (P = 0.048, Fisher's test). PLUGs were also larger than other single adenomas (mean 1.85 vs. 1.48cm, P = 0.021, t-test). Seventy-six percent of patients successfully underwent a unilateral or focused exploration. Six patients (9%) had persistent disease, which is double our group's overall average (4-5%). Conclusions: Primary hyperparathyroid patients with preoperative positive MIBI and negative US are more likely to have PLUGs. The Author(s), 2011 Harari Avital Department of Surgery, University of California, Los Angeles, CA, USA aut Mitmaker Elliot Division of Endocrine Surgery, University of California, San Francisco, CA, USA aut Grogan Raymon Division of Endocrine Surgery, University of California, San Francisco, CA, USA aut Lee James Division of Endocrine Surgery, Columbia University Medical Center, New York, NY, USA aut Shen Wen Division of Endocrine Surgery, University of California, San Francisco, CA, USA aut Gosnell Jessica Division of Endocrine Surgery, University of California, San Francisco, CA, USA aut Clark Orlo Division of Endocrine Surgery, University of California, San Francisco, CA, USA aut Duh Quan-Yang Division of Endocrine Surgery, University of California, San Francisco, CA, USA aut Annals of Surgical Oncology Springer-Verlag 18/6(2011-06-01), 1717-1722 1068-9265 18:6<1717 2011 18 10434 https://doi.org/10.1245/s10434-010-1493-2 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-010-1493-2 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Harari Avital Department of Surgery, University of California, Los Angeles, CA, USA aut NATIONALLICENCE 700 1- Mitmaker Elliot Division of Endocrine Surgery, University of California, San Francisco, CA, USA aut NATIONALLICENCE 700 1- Grogan Raymon Division of Endocrine Surgery, University of California, San Francisco, CA, USA aut NATIONALLICENCE 700 1- Lee James Division of Endocrine Surgery, Columbia University Medical Center, New York, NY, USA aut NATIONALLICENCE 700 1- Shen Wen Division of Endocrine Surgery, University of California, San Francisco, CA, USA aut NATIONALLICENCE 700 1- Gosnell Jessica Division of Endocrine Surgery, University of California, San Francisco, CA, USA aut NATIONALLICENCE 700 1- Clark Orlo Division of Endocrine Surgery, University of California, San Francisco, CA, USA aut NATIONALLICENCE 700 1- Duh Quan-Yang Division of Endocrine Surgery, University of California, San Francisco, CA, USA aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/6(2011-06-01), 1717-1722 1068-9265 18:6<1717 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer