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Hypothesis  Patients with primary hyperparathyroidism and negative preoperative localization imaging have a different outcome than patients with positive imaging.
Design  Prospective single-surgeon case series.
Setting  Referral center.
Patients  Forty-two patients with primary hyperparathyroidism, indications for surgery, and both cervical ultrasonographic results and technetium Tc 99m sestamibi nuclear images that were nonlocalizing over a 5- year span.
Main Outcome Measures  Extent of surgery required to produce cure; operative findings.