ABSTRACT
Surgical removal of solitary parathyroid adenomas or hyperplastic parathyroid glands is the current accepted treatment for primary hyperparathyroidism (1). Approximately 95% of patients with primary hyperparathyroidism are cured in the course of initial bilateral neck exploration performed by an experienced surgeon (1,2). A recent meta-analysis showed that 87% of 6331 patients with primary hyperparathyroidism had a solitary adenoma (3). Because patients with a solitary lesion may be cured by less extensive surgery, numerous imaging techniques for a preoperative localization of the lesion were developed in the 1980s. However, the vast majority of these techniques did not have a sufficiently high accuracy, and in 1991 the National Institutes of Health (NIH) consensus panel stated that routine imaging of the parathyroid glands before an initial neck exploration was not necessary. Subsequently, during the 1990s sestamibi parathyroid scintigraphy, first introduced in 1989, as well as high-resolution ultrasonography gained popularity as a preoperative parathyroid localization tool for directing a unilateral neck exploration or even more targeted surgery.
