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8%), resulting in unnecessary exploration of the contralateral side. In patients with sonographic appearance of a parathyroid gland larger than 1.2cm, MIBI scan would correctly change the operative plan in only 1 of the 287 (0.35%) patients. Our study suggests that the routine use of MIBI scans may have limited added value in patients with PHPT and a positive neck ultrasound, especially in those with adenoma size larger than 1.2cm. Positive ultrasound alone may be sufficient for the preoperative localization of parathyroid disease. Our s