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Cicek MT, Aslan M, Koca CF. The effect of peroperative ultrasound used by the surgeon in parathyroidectomy on operation time. Eur Arch Otorhinolaryngol 2025:10.1007/s00405-025-09319-7. [PMID: 40119143 DOI: 10.1007/s00405-025-09319-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Accepted: 03/03/2025] [Indexed: 03/24/2025]
Abstract
PURPOSE One of the endocrine conditions that endocrinologists see the most frequently is primary hyperparathyroidism, which is brought on by a parathyroid adenoma. Minimally invasive parathyroidectomy (MIP) has become the first line of treatment for primary hyperparathyroidism due to solitary parathyroid adenoma. Surgeon-performed ultrasonography (SUS), which has been found to be extremely accurate in localizing aberrant glands, has been employed preoperatively to augment the sensitivity of high-resolution ultrasonography (hUS). METHODS Two groups were randomly created from cases that underwent parathyroid surgery. In the first group, surgery was performed on 31 patients, taking into account the ultrasound results reported by radiology and the Technetium-99 m sestamibi scintigraphy results interpreted by the nuclear medicine clinic. In addition to the ultrasound results reported by radiology and the scintigraphy results interpreted by the nuclear medicine clinic, surgery was performed on 18 patients in the second group, that the surgeon applied ultrasound to them before the operation and separately evaluating the location of the parathyroid adenoma. Surgery time, hospital stay, pre and postoperative calcium and parathormon values were compared between the two groups. RESULTS When groups 1 and 2 were compared in terms of surgical time and hospital stay, there was a statistically significant difference between the two groups (p < 0.05). In Group 2, the duration of operation and hospital stay was significantly shortened. There was no statistically significant difference between the groups in terms of pre- and postoperative calcium and parathormone values (p > 0.05). CONCLUSIONS We believe that the time required for surgery after a radiologist and surgeon performing ultrasonography is less than that required for surgery after radiologist performed ultrasonography demonstrating the efficacy of the surgery plus a radiologist and surgeon performing ultrasonography combination. We determined that the surgery time was statistically shorter in patients who underwent a radiologist and surgeon performing ultrasonography.
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Affiliation(s)
- Mehmet Turan Cicek
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Malatya Inonu University, Malatya, Turkey
| | - Mehmet Aslan
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Malatya Inonu University, Malatya, Turkey
| | - Cigdem Firat Koca
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Malatya Inonu University, Malatya, Turkey.
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Salvador Egea P, Blanco Saiz I, Anda Apiñániz E, Redondo Expósito A, Erce García C, Pérez Otermin I, Cruz Vásquez N. Radioguided parathyroidectomy: How does it contribute to surgery? Cir Esp 2025; 103:127-134. [PMID: 39710006 DOI: 10.1016/j.cireng.2024.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 10/23/2024] [Indexed: 12/24/2024]
Abstract
OBJECTIVE To evaluate whether a radioguided approach allows a higher intraoperative detection rate of adenoma and a minimally invasive parathyroidectomy (MIP), with the same or better cure rate of hyperparathyroidism secondary to parathyroid adenoma. METHODS This was an observational, prospective, single-center study involving 254 consecutive patients with primary hyperparathyroidism, between 2017 and 2022. A total of 258 procedures were performed: 129 non radioguided (NRS) and 129 radioguided (RS) (112 with intravenous 99mTc- MIBI and 17 with ultrasound-guided intralesional 99mTc-MAA injection) with an intraoperative gamma probe and gamma camera. Follow-up was performed for at least one year. RESULTS There were no differences between the groups in terms of age, sex, preoperative calcium or parathyroid hormone levels, adenoma localization with 99mTc-MIBI-gammagraphy and ultrasound, and surgical morbidity. Intraoperative surgical localization was 97.7% in both groups. Statistically significant differences supported RS: It allowed to perform MIP (RS: 96.9%, NRS 88.4%; p = 0.015), also in patients with previous neck surgery (RS: 75%, NRS: 28%; p = 0.019) and with ectopic adenomas (RS: 93.3%, NRS: 71.4%; p = 0.012). The operative time was significantly shorter (RS: 51 min, NRS: 59.79 min; p = 0.005). There were no significant differences in the postoperative complications between the groups. Biochemical cure at six months was achieved in RS: 97.7% and NRS: 93.8% (p = 0.12). CONCLUSIONS Radioguided MIP is useful in ectopic adenomas and in patients with previous cervical surgery and allows a minimally invasive approach more frequently. It is a safe surgery, easily reproducible by an endocrine surgeon and requires usual equipment found in operating rooms.
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Affiliation(s)
- Pilar Salvador Egea
- Unidad de Cirugía Endocrina, Servicio de Cirugía General, Hospital Universitario de Navarra, Pamplona, Spain
| | - Isabel Blanco Saiz
- Servicio de Medicina Nuclear, Hospital Universitario de Navarra, Pamplona, Spain
| | - Emma Anda Apiñániz
- Servicio de Endocrinología, Hospital Universitario de Navarra, Pamplona, Spain
| | - Aitor Redondo Expósito
- Unidad de Cirugía Endocrina, Servicio de Cirugía General, Hospital Universitario de Navarra, Pamplona, Spain
| | - Cristina Erce García
- Unidad de Cirugía Endocrina, Servicio de Cirugía General, Hospital Universitario de Navarra, Pamplona, Spain.
| | - Irati Pérez Otermin
- Servicio de Cirugía General, Hospital Universitario de Navarra, Pamplona, Spain
| | - Naomi Cruz Vásquez
- Servicio de Medicina Nuclear, Hospital Universitario de Navarra, Pamplona, Spain
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Park D, Cho H, Lee E, Oh MY, Kim K, Chai YJ, Kim HY. Feasibility and Safety of transoral robotic parathyroidectomy: Initial experience with a new approach for parathyroid surgery. Asian J Surg 2024; 47:4300-4306. [PMID: 39068075 DOI: 10.1016/j.asjsur.2024.07.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/05/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND We present the initial outcomes of transoral robotic parathyroidectomy (TORP) using the transoral vestibular approach in patients with primary hyperparathyroidism (PHPT). METHOD A retrospective case series analysis was performed on patients diagnosed with PHPT between October 2016 and July 2019 who underwent transoral robotic surgery for parathyroidectomy. RESULTS Thirteen patients (five males and eight females) successfully underwent TORP at our institution from October 2016 to July 2019. Eight patients underwent TORP alone, and five underwent TORP combined with transoral robotic thyroidectomy for papillary thyroid carcinoma. No intra- or postoperative complications were observed. Serum levels of parathyroid hormone, total calcium, and ionized calcium decreased to normal postoperatively and continued to decrease during the follow-up period. CONCLUSION This study suggests that TORP holds promise for the treatment of patients with PHPT with the advantages of the robotic procedure, including dynamic visualization and meticulous dissection.
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Affiliation(s)
- Dawon Park
- Department of Surgery, Korea University Anam Hospital, Republic of Korea
| | - Hyewon Cho
- Korea University Medical Center, Seoul, Republic of Korea
| | - Eunbee Lee
- Korea University Medical Center, Seoul, Republic of Korea
| | - Moon Young Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Young Jun Chai
- Department of Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hoon Yub Kim
- Department of Surgery, Korea University Anam Hospital, Republic of Korea.
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Scott-Coombes D, Stechman M, Patel N, Egan R. Intraoperative parathyroid hormone assay benefits surgery for primary hyperparathyroidism when preoperative localisation is negative or not performed. Ann R Coll Surg Engl 2024. [PMID: 39319455 DOI: 10.1308/rcsann.2024.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024] Open
Abstract
INTRODUCTION Parathyroid localisation is now routine before first-time surgery for patients with primary hyperparathyroidism (PHPT). The aim of this study was to investigate the contribution of intraoperative parathyroid hormone (PTH) (ioPTH) in patients in whom localisation was either not undertaken or negative for a tumour. METHODS This was a retrospective study of patients undergoing first-time parathyroidectomy for PHPT in a regional endocrine centre. Data were collected prospectively (Microsoft Excel) and the all-Wales electronic patient record portal was used to retrieve missing data. Statistical analysis appropriate for nonparametric data was undertaken, with statistical significance reached when p<0.05. RESULTS Between 1 July 2002 and 31 December 2022, 1,490 patients underwent a first-time parathyroidectomy for PHPT. Of this cohort, 1,133 patients had at least one positive imaging modality; the study group consisted of 343 patients that had negative imaging, and 13 that had no preoperative localisation. Patients with MEN-1 (n=26), an incorrect diagnosis (n=4), or less than six months follow-up (n=6) were excluded. Of the remaining 321, 106 patients underwent surgery without ioPTH (Group A), 215 cases with ioPTH (Group B). In Group B there were more women (170 female/45 male; 79% vs 67 female/37 male; 63% p=0.002, chi-squared), lower calcium (median [range] 2.77 [2.63-3.24] mmol/l; vs 2.85 [2.60-4.52] p=0.001) and lower PTH (12.0pmol/l [3.4-39.5] vs 14.4 [3.9-97.0] p=0.001) and smaller weights of resected tissue (320mg [50-9,000] vs 454 [46-8,280] p=0.02) (Student's t-test). The rate of multiple gland disease was similar (Group A 29%; Group B 27%). The rate of normocalcaemia at 6 months was significantly higher when ioPTH was used (Group B 202/215; 94% vs Group A 90/106; 85%) (p=0.014, chi-square test). The sensitivity and specificity of ioPTH was 98.5% [confidence interval (CI) 96.2-99.6] and 91.2% [80.7-97.0] (positive predictive value 99.9%, CI 93.6-100.0). CONCLUSION Despite milder hyperparathyroidism and smaller tumour weight, the outcome in patients in whom ioPTH was used was superior, with failure rates 2.5-fold higher in the cohort where ioPTH was not utilised. The results of this study demonstrate that ioPTH is a valuable adjunct for the surgeon in cases where localisation has failed or not been undertaken.
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Affiliation(s)
| | | | - N Patel
- University Hospital of Wales, UK
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Sperotto B, Meurer N, Meyer A, Ahmad-Nejad P, Bösing N, Lange N, Dotzenrath C, Alesina PF. A new approach for perioperative parathyroid hormone (PTH) measurement to establish cure in patients with primary hyperparathyroidism. Langenbecks Arch Surg 2024; 409:285. [PMID: 39302485 DOI: 10.1007/s00423-024-03472-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 09/06/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE In this study, we analyse the possibility to omit pre-incision PTH measurement since we routinely measure it at the time of pre-surgery ambulatory admission. METHODS A total of 435 patients were enrolled. All patients with pHPT included underwent pre-surgical PTH level assessment as part of the pre-admission preparation to surgery. Intraoperative PTH was routinely assessed after induction of the anaesthesia (pre-incision PTH) and 15 min after resection of the enlarged gland(s) (post-excision PTH). Moreover, calcium and PTH levels were routinely assessed on the first postoperative day. Cure was defined as an intraoperative drop of > 50% or into normal range on first post-operative day. RESULTS The median value of the preoperative and pre-incision PTH were both 127 pg/ml (p = ns). Thirty-two patients (7.3%) exhibited a not appropriate drop of post-excision PTH level. Nevertheless, nineteen of them (59.3%) showed a satisfying PTH drop on 1st POD. Ten patients (2.3%) experienced a persistent disease with six achieving cure through reoperation. Additionally, three patients (0.6%) showed normalization of calcium and PTH values during the follow-up. Three patients, apparently deemed cured after an adequate PTH-drop on the day of surgery, showed persistence. Cure rate at primary surgery was 98.4%. Accuracy of our simplified protocol is 99.3%. CONCLUSION Pre-incision PTH is not superior to preoperative PTH blood test and can be omitted without compromising the sensitivity of cure prediction. One blood sample 15 min after resection, along with the postoperative PTH value on the day after surgery, is sufficient to predict the surgical outcome bearing the cost of a very low reoperation rate.
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Affiliation(s)
- Beatrice Sperotto
- Klinik für Endokrine Chirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Heusnerstraße 40, 42283, Wuppertal, Germany.
- Universitá degli studi di Genova, Genoa, Italy.
| | - Natalie Meurer
- Klinik für Endokrine Chirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Heusnerstraße 40, 42283, Wuppertal, Germany
| | - Anke Meyer
- Klinik für Endokrine Chirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Heusnerstraße 40, 42283, Wuppertal, Germany
| | - Parviz Ahmad-Nejad
- Institut für Medizinische Labordiagnostik, Helios Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Heusnerstraße 40, 42283, Wuppertal, Germany
| | - Norbert Bösing
- Klinik für Endokrine Chirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Heusnerstraße 40, 42283, Wuppertal, Germany
| | - Nadine Lange
- Klinik für Endokrine Chirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Heusnerstraße 40, 42283, Wuppertal, Germany
| | - Cornelia Dotzenrath
- Klinik für Endokrine Chirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Heusnerstraße 40, 42283, Wuppertal, Germany
| | - Pier Francesco Alesina
- Klinik für Endokrine Chirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Heusnerstraße 40, 42283, Wuppertal, Germany
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Kurzawinski TR, Zielke A, Busch M, Wagner J, Soromani C, Abdelsalam A, Abdel-Aziz T, Garcia VR, Matias M, Morley S, Barth J, Smaxwil CA. Ultrafast intraoperative parathyroid hormone monitoring system: prospective, multicentre, clinical validity study. Br J Surg 2024; 111:znae101. [PMID: 38713606 DOI: 10.1093/bjs/znae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/17/2024] [Accepted: 04/02/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Intraoperative parathyroid hormone (PTH) monitoring is a proven and reliable adjunct to parathyroid surgery, able to improve the outcomes and efficiency of the diagnostic and therapeutic pathway for patients with primary hyperparathyroidism. This study evaluated the innovative, compact, fully automated NBCL CONNECT Analyzer, which can measure whole-blood PTH in 5 min. METHODS A prospective multicentre study was conducted in stages: results reviews, recommendations, and implementation of improvements to the mechanical design, components of cartridges, calibration, and sampling protocols. Patients undergoing parathyroidectomy had PTH levels measured on the Analyzer and main laboratory platforms, either Roche or Abbott. The Miami criterion of a 50% drop in PTH concentration was used to define biochemical cure during surgery, and normal postoperative calcium level as cure of primary hyperparathyroidism. Measurements on the Analyzer were done by laboratory staff in London and nurses in Stuttgart. The Pearson coefficient (R) and Wilcoxon test were used for statistical analysis. RESULTS Some 234 patients (55 male, 179 female) with a median age of 58.5 (age full range 15-88) years underwent parathyroidectomy (195 minimally invasive, 38 bilateral neck exploration, 1 thoracoscopic; 12 conversions) for primary hyperparathyroidism between November 2021 and July 2022. Primary hyperparathyroidism was cured in 225 patients (96.2%). The sensitivity, specificity, and overall accuracy of the Analyzer assay in predicting biochemical cure were 83.9, 100, and 84.8% in phase 1; 91.2, 100, and 91.3% in phase 2; and 98.6, 100, and 98.6% in phase 3. There were no false-positive results (positive predictive value 100%). Correlations between Analyzer measurements and those obtained using the Roche device were very strong (R = 0.98, P < 0.001 in phase 1; R = 0.92, P < 0.001 in phase 2; R = 0.94, P < 0.001 in phase 3), and correlations for Analyzer readings versus those from the Abbott platform were strong (R = 0.82, P < 0.001; R = 0.89, P < 0.001; R = 0.91, P < 0.001). The Analyzer showed continued good mechanical performance, with stable and repeatable operations (calibrations, quality controls). Introducing a stricter sampling protocol and improvements in the clot-detecting system led to a decrease in the number of clotted samples and false-negative results. Outcomes were not affected by measurements performed either by nurses or laboratory staff. CONCLUSION Intraoperative PTH monitoring during parathyroid surgery can be done accurately, simply, and quickly in whole blood using the Analyzer.
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Affiliation(s)
- Tom R Kurzawinski
- Centre for Endocrine Surgery, University College London Hospitals NHS Foundation Trust, Great Ormond Street Hospital, London, UK
- Endocrine Surgery unit, London Clinic Hospitals, London, UK
| | - Andreas Zielke
- Endokrine Chirurgie am Diakonieklinikum Stuttgart, Stuttgart, Germany
| | - Mirjam Busch
- Endokrine Chirurgie am Diakonieklinikum Stuttgart, Stuttgart, Germany
| | - Joachim Wagner
- Endokrine Chirurgie am Diakonieklinikum Stuttgart, Stuttgart, Germany
| | - Christina Soromani
- Centre for Endocrine Surgery, University College London Hospitals NHS Foundation Trust, Great Ormond Street Hospital, London, UK
| | - Alaa Abdelsalam
- Centre for Endocrine Surgery, University College London Hospitals NHS Foundation Trust, Great Ormond Street Hospital, London, UK
| | - Tarek Abdel-Aziz
- Centre for Endocrine Surgery, University College London Hospitals NHS Foundation Trust, Great Ormond Street Hospital, London, UK
| | - Virginia Rozalen Garcia
- Centre for Endocrine Surgery, University College London Hospitals NHS Foundation Trust, Great Ormond Street Hospital, London, UK
| | | | - Sujiwa Morley
- Endocrine Surgery unit, London Clinic Hospitals, London, UK
| | - Julian Barth
- Endocrine Surgery unit, London Clinic Hospitals, London, UK
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Lee JS, Lee JS, Jeong H, Yun HJ, Chang H, Kim SM, Lee YS, Chang HS. Robotic parathyroidectomy is a feasible technique for primary hyperparathyroidism. Langenbecks Arch Surg 2023; 409:10. [PMID: 38103090 PMCID: PMC10725346 DOI: 10.1007/s00423-023-03182-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Focused parathyroidectomy is the gold standard treatment modality for primary hyperparathyroidism, which allows accurate preoperative localization. Robotic parathyroidectomy has emerged as a feasible procedure for focused parathyroidectomy. This study aimed to report the experiences of gasless robotic transaxillary parathyroidectomy for primary hyperparathyroidism in a single center. METHODS We assessed the data obtained from patients who underwent gasless robotic parathyroidectomy with the transaxillary approach between December 2013 and August 2022 and were diagnosed with primary hyperparathyroidism at our institute. The data included clinical, biochemical, and pathological features and operation time. RESULTS Of the 12 patients, 11 were women and one was a man. The median age of the patients was 44.5 years (range: 15-65 years). The median preoperative maximum mass diameters on ultrasonography and neck computed tomography were 1.2 ± 0.5 and 1.1 ± 0.6 cm, respectively. The median size of the postoperative maximum mass diameter in gross pathology was 1.3 ± 0.4 cm. The location of the enlarged parathyroid was left superior in five patients, right inferior in four, left inferior in three, and no right superior in one. In the final pathological examination, all cases were parathyroid adenomas. Only one case experienced a postoperative bleeding complication. At six months from surgery, average of an axillary scar length was 5.85 cm, and an average width was 0.21 cm. The mean operative time was 113 ± 48 min. The mean robot docking and console times were 9 ± 5 and 47 ± 52 min, respectively. CONCLUSIONS Robotic transaxillary parathyroidectomy is a feasible technique in select patients with primary hyperparathyroidism and preoperatively localized disease. The gasless robotic transaxillary approach provides procedural safety as well as superior cosmetic results without a neck scar.
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Affiliation(s)
- Jin Seok Lee
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Jun Sung Lee
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Hojung Jeong
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Hyeok Jun Yun
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Hojin Chang
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Seok Mo Kim
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea.
| | - Hang-Seok Chang
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
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Vaghaiwalla TM, Armstrong VL, Saghira C, Lew JI. Operative success is achieved regardless of ioPTH criterion used during focused parathyroidectomy for sporadic primary hyperparathyroidism. Am J Surg 2023; 226:604-608. [PMID: 37438175 DOI: 10.1016/j.amjsurg.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/27/2023] [Accepted: 06/24/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Focused parathyroidectomy (F-PTX) guided by intraoperative parathormone (ioPTH) monitoring may result in higher operative failure rates from missed multiglandular disease (MGD) in patients with sporadic primary hyperparathyroidism (spHPT) when ioPTH levels do not reach normal range. METHODS A retrospective review included 690 patients with spHPT who underwent F-PTX and ioPTH monitoring were divided into 2 groups: >50% ioPTH decrease to normal range, and >50% ioPTH decrease to above normal range. Operative success, recurrence, bilateral/unilateral neck exploration (BNE/UNE), MGD were evaluated. RESULTS 533 patients demonstrated >50% ioPTH decrease to normal range, and 157 patients >50% ioPTH decrease to above normal range. There were no differences in operative success 99% vs. 97%, recurrence 2.5% vs. 5%, BNE 12% vs. 11%, UNE 4% vs. 5%, or MGD 4% vs. 4%, (p > 0.05) with 46 months mean follow-up. CONCLUSIONS There were no differences in operative success, failure, BNE, UNE or MGD regardless of ioPTH criterion used for F-PTX.
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Affiliation(s)
- Tanaz M Vaghaiwalla
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
| | | | - Cima Saghira
- DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - John I Lew
- Division of Endocrine Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Giudici F, Fortuna L, Russo E, Badii B, Coratti F, Staderini F, Morandi A, Sparano C, Petrone L, Cianchi F, Perigli G. Surgery for Sporadic Primary Hyperparathyroidism: Evolution over the Last Twenty Years in a Monocentric Setting. Cancers (Basel) 2023; 15:cancers15092581. [PMID: 37174047 PMCID: PMC10177273 DOI: 10.3390/cancers15092581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
The sporadic parathyroid pathology of surgical interest is primarily limited to lesions that are the cause of hormonal hyperfunction (primary hyperparathyroidism). In recent years, parathyroid surgery has evolved significantly, and numerous minimally invasive parathyroidectomy techniques have been developed. In this study, we describe a single-center and well-documented case series of sporadic primary hyperparathyroidism, surgically treated by a single operator in the Endocrine Surgery Unit of the Surgical Clinic of the University of Florence-Careggi University Hospital, recorded and updated in a dedicated database that embraces the entire evolutionary timeframe of parathyroid surgery. From January 2000 to May 2020, 504 patients with a clinical and instrumental diagnosis of hyperparathyroidism were included in the study. The patients were divided into two groups, based on the application of intraoperative parathyroid hormone (ioPTH). The analysis shows that the use of ioPTH with the rapid method could be ineffective in helping surgeons in primary operations, especially when ultrasound and scintiscan are concordant. The advantages obtained by not using intraoperative PTH are not only economic. In fact, our data shows shorter operating and general anesthesia times and hospital stays, having an important impact on patient biological commitment. Furthermore, the significant reduction in operating time makes it possible to almost triple the volume of activity in the same unit of time available, with an undeniable advantage for the reduction of waiting lists. In recent years, minimally invasive approaches have allowed surgeons to reach the best compromise between invasiveness and aesthetic results.
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Affiliation(s)
- Francesco Giudici
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy
| | - Laura Fortuna
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy
| | - Edda Russo
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy
| | - Benedetta Badii
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy
| | - Francesco Coratti
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy
| | - Fabio Staderini
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy
| | - Alessio Morandi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy
| | - Clotilde Sparano
- Department of Biomedical, Experimental and Clinical Sciences Mario Serio, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy
| | - Luisa Petrone
- Department of Biomedical, Experimental and Clinical Sciences Mario Serio, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy
| | - Fabio Cianchi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy
| | - Giuliano Perigli
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy
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Ozdemir E, Ozden S, Tutuncu T, Daglar G, Yuksek YN. Does the intraoperative parathormone monitoring really affect surgical success in primary hyperparathyroidism? Acta Chir Belg 2023; 123:118-123. [PMID: 34253156 DOI: 10.1080/00015458.2021.1955185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Surgery is the only curative treatment option for primary hyperparathyroidism (PHPT). The intraoperative parathormone (IOPTH) monitoring is recommended to confirm that all pathological glands have been removed. This study aimed to evaluate the effect of IOPTH monitoring on the surgical success of parathyroidectomy performed for PHPT. METHODS The demographic, biochemical, operative and pathological data of patients who underwent parathyroidectomy for PHPT in a single institute over a three-year period were retrospectively analyzed. RESULTS The total number of patients included in the study was 182. The IOPTH monitoring had been performed in 92 patients (50.5%). The IOPTH monitoring had a clinical accuracy of 89.2%, sensitivity of 89.8%, and specificity of 75%. The rate of surgical success was 95.7% in the group with IOPTH monitoring and 91.1% in the group without this monitoring (p = .21). Of the 40 patients who underwent minimally invasive parathyroidectomy (MIP), 25 patients had IOPTH monitoring, and the surgery was successful for all these patients (100%). Surgical success was achieved in 14 (93.3%) patients who underwent MIP without IOPTH monitoring (p = .37). CONCLUSION The IOPTH monitoring is a reliable test with high accuracy. The lack of IOPTH monitoring may result in lower than acceptable surgical success rates. Even though preoperative localization studies are compatible with surgical findings, the IOPTH monitoring should also be undertaken, especially in patients scheduled for MIP for PHPT.
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Affiliation(s)
- Egemen Ozdemir
- Department of Surgery, Inonu University, Malatya, Turkey
| | - Sabri Ozden
- Department of Surgery, University of Health Sciences, Konya City Hospital, Konya, Turkey
| | - Tanju Tutuncu
- Department of Surgery, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Gul Daglar
- Department of Surgery, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Yunus Nadi Yuksek
- Department of Surgery, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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11
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Parathyroidectomy for primary hyperparathyroidism: A retrospective analysis of localization, surgical characteristics, and treatment outcomes. Asian J Surg 2023; 46:788-793. [PMID: 35850895 DOI: 10.1016/j.asjsur.2022.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/11/2022] [Accepted: 07/07/2022] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To evaluate parathyroidectomy for primary hyperparathyroidism (PHPT) regarding localization, surgical characteristics, and treatment outcomes. METHODS Seventy-eight patients who underwent parathyroidectomy for PHPT were retrospectively reviewed. The results were analyzed according to intraoperative localization technique (IOLT), intraoperative parathyroid hormone (IOPTH) monitoring, and intraoperative nerve monitoring (IONM). The localization accuracy of ultrasonography (US), computed tomography (CT), and single-photon emission computed tomography (SPECT)-CT with sestamibi Tc99m was evaluated. RESULTS Parathyroidectomy was successfully completed in all 78 patients, achieving 100% surgical cure. For 60 patients with IOPTH monitoring, 10-min IOPTH decreased >50% from baseline in 57 (95.0%), and they achieved surgical cure. In the remaining three (5.0%) patients with ≤50% decrease in 10-min IOPTH, 20-min IOPTH decreased >50% from baseline in two (3.3%) patients, achieving surgical cure without additional neck exploration. There were no differences in surgical cure and complications as a function of IOLT use or IOPTH monitoring. Operating time was significantly shorter with IOLT and IOPTH monitoring than without (IOLT: 70.9 min vs. 88.0 min, p = 0.013; IOPTH: 74.9 min vs. 91.9 min, p = 0.037). All 78 patients had adenoma including one patient with a double adenoma. Vocal cord paralysis was not observed in our series, regardless of IONM. US, CT, and SPECT-CT localized the pathological parathyroid gland accurately in 88.1%, 85.5%, and 86.8% of patients, respectively (p = 0.894). CONCLUSION The surgical outcomes of parathyroidectomy for PHPT were excellent regardless of IOLT and IOPTH monitoring. However, these techniques can maximize the performance of parathyroid surgery by reducing operating time and rescuing challenging cases.
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Werenski HE, Nguyen CJ, Johansson ED, Bunch PM, Randle RW. Value of Old Imaging for Patients Undergoing Parathyroidectomy for Primary Hyperparathyroidism. J Surg Res 2023; 282:147-154. [PMID: 36274449 DOI: 10.1016/j.jss.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/04/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Although imaging plays no role in diagnosing primary hyperparathyroidism (PHPT), preoperative localization is essential for a focused parathyroidectomy. We hypothesized that reviewing imaging obtained prior to PHPT diagnosis can identify enlarged parathyroid glands and provide information that might potentially impact the preoperative evaluation and intraoperative course of patients undergoing parathyroidectomy. METHODS We included adult patients with PHPT who underwent parathyroidectomy between October 2015 and October 2020 and had contrast-enhanced computed tomography (CT) imaging of the lower neck and upper chest obtained prior to diagnosis for unrelated indications. A radiologist reviewed the prediagnosis CTs blinded to subsequent parathyroid localization imaging and operative findings. A surgeon assessed the radiologist's findings in the context of each case to determine the potential impact of information from old imaging on surgical decision-making. RESULTS We identified at least one enlarged parathyroid gland on prior contrast-enhanced CT in 30 (75%) of 40 included patients. Despite old imaging enabling correct localization, 60% of these 30 underwent dedicated parathyroid imaging prior to parathyroidectomy. Knowledge of the enlarged parathyroid(s) on prior imaging might have allowed a more focused approach in 10.0% and prompted a more thorough exploration in 13.3%. In the total cohort, reviewing prior imaging could have provided information capable of changing the preoperative evaluation in 52.5% and the operative course in 17.5%. CONCLUSIONS The identification of enlarged parathyroid glands on contrast-enhanced CT imaging that predates a diagnosis of PHPT is possible. Prospective studies might verify the impact of these findings on the preoperative evaluation and operative course of patients undergoing parathyroidectomy.
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Affiliation(s)
- Hope E Werenski
- Department of Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Christopher J Nguyen
- Department of Radiology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Erik D Johansson
- Department of Radiology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Paul M Bunch
- Department of Radiology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Reese W Randle
- Department of Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina.
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13
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Beyond the AJR: Largest Systematic Review to Date Confirms High Accuracy of 4D CT in Parathyroid Localization. AJR Am J Roentgenol 2023; 220:305. [PMID: 35766530 DOI: 10.2214/ajr.22.28127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Martlı HF, Saylam B, Er S, Yücel Ç, Tez M. Evaluation of preoperative procollagen type 1 N-terminal peptide and collagen type 1 C-telopeptide levels in the prediction of postoperative hypocalcemia in patients undergoing parathyroidectomy due to primary hyperparathyroidism. Langenbecks Arch Surg 2023; 408:71. [PMID: 36720758 DOI: 10.1007/s00423-023-02813-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 01/17/2023] [Indexed: 02/02/2023]
Abstract
PURPOSE This study is aimed at investigating the role of preoperative procollagen type 1 N-terminal peptide (P1NP) and collagen type 1 C-telopeptide (CTx) levels in predicting the development of postoperative hypocalcemia in primary hyperparathyroidism (PHPT). METHODS In this prospective observational study, preoperative complaints of patients with primary hyperparathyroidism and their urea, creatinine, glomerular filtration rate (GFR), calcium, albumin, urinary calcium, parathyroid hormone, and bone mineral density (BMD) were recorded. P1NP and CTx levels were analyzed in blood samples taken the day before surgery, and their relationship with calcium levels obtained on the first postoperative day was examined. RESULTS The median age was 53 years for patients who developed hypocalcemia and 62 years for those who did not develop hypocalcemia (p = 0.01). The urea, creatinine, and GFR values were determined as 22 mcg/dl, 0.61 mcg/dl, and 105 ml/min, respectively, for the hypocalcemia group (Group 1) and 30.5 mcg/dl, 0.74 mcg/dl, and 90 ml/min, respectively, for the non-hypocalcemia group (Group 2) (p = 0.02, 0.001, and 0.01, respectively). The BMD femur Z-score was - 0.1 in Group 1 and 0.8 in the Group 2 (p = 0.02). The mean CTx values were 4.14 pg/dl and 1.98 pg/dl (p = 0.036), and the mean P1NP values were 252.84 mcg/dl and 269.04 mcg/dl (p = 0.427) for Groups 1 and 2, respectively. According to multivariate analysis, only CTx was a significant independent predictor of hypocalcemia (odds ratio 1.739). CONCLUSION CTx level is a significant factor in predicting the risk of developing early postoperative hypocalcemia in patients scheduled for surgery due to primary hyperparathyroidism.
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Affiliation(s)
- Hüseyin Fahri Martlı
- General Surgery Department, Ankara Atatürk Sanatoryum Training and Research Hospital, Sanatoryum Cad., Pınarbaşı Mah., Ardahan Sok., Keçiören, Ankara, Turkey.
| | - Barış Saylam
- General Surgery Department, Ankara City Hospital, Üniversiteler Mah., Dumlupınar Cad, Çankaya, Ankara, Turkey
| | - Sadettin Er
- General Surgery Department, Ankara City Hospital, Üniversiteler Mah., Dumlupınar Cad, Çankaya, Ankara, Turkey
| | - Çiğdem Yücel
- Medical Biochemistry Department, Gülhane Training and Research Hospital, Etlik Mah., Dr. Tevfik Sağlam Cad, Keçiören, Ankara, Turkey
| | - Mesut Tez
- General Surgery Department, Ankara City Hospital, Üniversiteler Mah., Dumlupınar Cad, Çankaya, Ankara, Turkey
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Perrier N, Lang BH, Farias LCB, Poch LL, Sywak M, Almquist M, Vriens MR, Yeh MW, Shariq O, Duh QY, Yeh R, Vu T, LiVolsi V, Sitges-Serra A. Surgical Aspects of Primary Hyperparathyroidism. J Bone Miner Res 2022; 37:2373-2390. [PMID: 36054175 DOI: 10.1002/jbmr.4689] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/18/2022] [Accepted: 08/24/2022] [Indexed: 11/12/2022]
Abstract
Parathyroidectomy (PTX) is the treatment of choice for symptomatic primary hyperparathyroidism (PHPT). It is also the treatment of choice in asymptomatic PHPT with evidence for target organ involvement. This review updates surgical aspects of PHPT and proposes the following definitions based on international expert consensus: selective PTX (and reasons for conversion to an extended procedure), bilateral neck exploration for non-localized or multigland disease, subtotal PTX, total PTX with immediate or delayed autotransplantation, and transcervical thymectomy and extended en bloc PTX for parathyroid carcinoma. The systematic literature reviews discussed covered (i) the use of intraoperative PTH (ioPTH) for localized single-gland disease and (ii) the management of low BMD after PTX. Updates based on prospective observational studies are presented concerning PTX for multigland disease and hereditary PHPT syndromes, histopathology, intraoperative adjuncts, localization techniques, perioperative management, "reoperative" surgery and volume/outcome data. Postoperative complications are few and uncommon (<3%) in centers performing over 40 PTXs per year. This review is the first global consensus about surgery in PHPT and reflects the current practice in leading endocrine surgery units worldwide. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Nancy Perrier
- Department of Surgical Oncology, Section of Surgical Endocrinology, University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Brian H Lang
- Department of Surgery, Queen Mary Hospital, Pokfulam, Hong Kong
| | | | - Leyre Lorente Poch
- Endocrine Surgery Unit, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mark Sywak
- Endocrine Surgery Unit, University of Sydney, Sydney, Australia
| | - Martin Almquist
- Department of Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Menno R Vriens
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center, Utrecht, The Netherlands
| | - Michael W Yeh
- Department of Surgery, Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Omair Shariq
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Headington, UK
| | - Quan-Yang Duh
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Randy Yeh
- Memorial Sloan Kettering Cancer Center, Molecular Imaging and Therapy Service, New York, NY, USA
| | - Thinh Vu
- Neuroradiology Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Virginia LiVolsi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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16
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Lerner A, Grant EG, Acharya J, Chambers TN, Maceri DR, Cen SY, Tchelepi H. Utility of Contrast-Enhanced Ultrasound and 4-Dimensional Computed Tomography for Preoperative Detection and Localization of Parathyroid Adenomas Compared With Surgical Results. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2295-2306. [PMID: 34918364 DOI: 10.1002/jum.15916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To investigate the accuracy, sensitivity, and specificity of contrast-enhanced ultrasound (CEUS) for detection of parathyroid adenomas and compare it to those of 4-dimensional computed tomography (4DCT), which has been established as a reliable, effective tool for preoperative localization of parathyroid adenomas. METHODS About 27 patients with suspected parathyroid pathology underwent imaging evaluations with 4DCT and CEUS and 22 patients subsequently underwent surgical resection of parathyroid lesions. 4DCT and CEUS were performed and interpreted by consensus of two expert radiologists with extensive experience in each modality. Assessment for the side, z-axis (craniocaudal axis), and quadrant of the pathologically proven lesion was performed based on the surgical report. RESULTS For single-gland disease, the accuracy for CEUS localization to the correct quadrant and side were 81.0 and 90.1% respectively. For single-gland disease, the accuracy for 4DCT localization to the correct quadrant and side were 81.0 and 90.5% respectively. 4DCT localization sensitivity and specificity were comparable to those for CEUS. 4DCT allowed for accurate diagnosis in multigland disease in contradistinction to CEUS. CONCLUSIONS CEUS is a noninvasive, real-time imaging technique that has relatively high diagnostic confidence and accuracy of localization which are comparable to the accuracy of 4DCT for preoperative parathyroid adenoma detection, characterization, and localization. This technique should be considered for primary preoperative diagnosis, especially in younger patients.
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Affiliation(s)
- Alexander Lerner
- Department of Radiology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Edward G Grant
- Department of Radiology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jay Acharya
- Department of Radiology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tamara N Chambers
- Department of Otolaryngology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dennis R Maceri
- Department of Otolaryngology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Steven Yong Cen
- Department of Neurology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hisham Tchelepi
- Department of Radiology, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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17
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Saito Y, Ikeda Y, Takami H, Abdelhamid Ahmed AH, Nakao A, Katoh H, Ho K, Tomita M, Sato M, Tolley NS, Randolph GW. Scoping review of approaches used for remote-access parathyroidectomy: A contemporary review of techniques, tools, pros and cons. Head Neck 2022; 44:1976-1990. [PMID: 35467046 DOI: 10.1002/hed.27068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 11/09/2022] Open
Abstract
After our coauthors described the first remote-access parathyroidectomy (RAP) series in 2000, several other approaches were developed. No systematic review has been performed to classify and evaluate RAP techniques. We performed a literature search using PubMed and Cochrane Library (CENTRAL). A total of 71 studies met our inclusion/exclusion criteria. RAP can be categorized into five approaches: (1) endoscopic and robotic axillary, (2) anterior chest, (3) transoral, (4) retroauricular, and (5) a combination of these approaches. The limited data in the literature suggest that the cure rates and safety of RAP are in no way inferior to those of open parathyroidectomy. Each approach has its advantages and disadvantages, and the recommendations for the selection of each approach are listed. The selection of approach methods might depend on the surgeon's experience and familiarity and the patient's preference and disease status.
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Affiliation(s)
- Yoshiyuki Saito
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, International Goodwill Hospital, Yokohama, Japan
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yoshifumi Ikeda
- Department of Surgery, International University of Health and Welfare, Atami Hospital, Atami, Japan
| | | | - Amr H Abdelhamid Ahmed
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Atsushi Nakao
- Department of Surgery Gastroenterology Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Hiroshi Katoh
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Keiso Ho
- Department of Surgery, International Goodwill Hospital, Yokohama, Japan
| | - Masato Tomita
- Department of Surgery, International Goodwill Hospital, Yokohama, Japan
| | - Michio Sato
- Department of Surgery, International Goodwill Hospital, Yokohama, Japan
| | | | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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18
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Dekorsy FJ, Beyer L, Spitzweg C, Schmidmaier R, Todica A, Trupka A, Cyran CC, Berger F, Ladurner R, Zimmermann P, Knösel T, Bartenstein P, Lottspeich C, Wenter V. Preoperative Imaging with [ 18F]-Fluorocholine PET/CT in Primary Hyperparathyroidism. J Clin Med 2022; 11:jcm11102944. [PMID: 35629070 PMCID: PMC9143217 DOI: 10.3390/jcm11102944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 01/25/2023] Open
Abstract
Primary hyperparathyroidism (pHPT) is a common endocrine disorder due to hyperfunctioning parathyroid glands. To date, the only curing therapy is surgical removal of the dysfunctional gland, making correct detection and localization crucial in order to perform a minimally invasive parathyroidectomy. 18F-Fluorocholine positron emission tomography/computed tomography (18F-FCH PET/CT) has shown promising results for the detection of pHPT, suggesting superiority over conventional imaging with ultrasounds or scintigraphy. A total of 33 patients with pHPT who had negative or equivocal findings in conventional imaging received 18F-FCH PET/CT preoperatively and were retrospectively included. A pathological hyperfunctional parathyroid gland was diagnosed in 24 cases (positive PET, 72.7%), 4 cases showed equivocal choline uptake (equivocal PET, 12.1%), and in 5 cases, no enhanced choline uptake was evident (negative PET, 15.2%). Twelve of the twenty-four detected adenoma patients underwent surgery, and in all cases, a pathological parathyroid adenoma was resected at the site detected by PET/CT. Two of the six patients without pathological choline uptake who received a parathyroidectomy revealed no evidence of parathyroid adenoma tissue in the histopathological evaluation. This retrospective study analyzes 18F-FCH PET/CT in a challenging patient cohort with pHPT and negative or equivocal conventional imaging results and supports the use of 18F-FCH for the diagnosis of hyperfunctional parathyroid tissue, especially in this patient setting, with a 100% true positive and true negative detection rate. Our study further demonstrates the importance of 18F-FCH PET/CT for successful surgical guidance.
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Affiliation(s)
- Franziska J. Dekorsy
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (L.B.); (A.T.); (P.B.); (V.W.)
- Correspondence:
| | - Leonie Beyer
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (L.B.); (A.T.); (P.B.); (V.W.)
| | - Christine Spitzweg
- Department of Internal Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (R.S.); (C.L.)
| | - Ralf Schmidmaier
- Department of Internal Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (R.S.); (C.L.)
| | - Andrei Todica
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (L.B.); (A.T.); (P.B.); (V.W.)
| | - Arnold Trupka
- Department of Endocrine Surgery, Starnberg Hospital, 82319 Starnberg, Germany;
| | - Clemens C. Cyran
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (C.C.C.); (F.B.)
| | - Frank Berger
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (C.C.C.); (F.B.)
| | - Roland Ladurner
- Department of Surgery, University Hospital, LMU Munich, 81377 Munich, Germany; (R.L.); (P.Z.)
- Department of Surgery, Martha-Maria Krankenhaus, 81377 Munich, Germany
| | - Petra Zimmermann
- Department of Surgery, University Hospital, LMU Munich, 81377 Munich, Germany; (R.L.); (P.Z.)
| | - Thomas Knösel
- Institute of Pathology, Faculty of Medicine, University Hospital, LMU Munich, 81377 Munich, Germany;
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (L.B.); (A.T.); (P.B.); (V.W.)
| | - Christian Lottspeich
- Department of Internal Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (R.S.); (C.L.)
| | - Vera Wenter
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (L.B.); (A.T.); (P.B.); (V.W.)
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Patel N, Mihai R. Long-term Cure of Primary Hyperparathyroidism After Scan-Directed Parathyroidectomy: Outcomes From A UK Endocrine Surgery Unit. World J Surg 2022; 46:2189-2194. [PMID: 35412058 DOI: 10.1007/s00268-022-06556-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Two-decades ago, the advent of sestamibi scintigraphy led to an enthusiastic acceptance of minimally invasive parathyroidectomy (MIP) in most surgical centres. More recently, concerns have been raised about the efficacy of limited neck exploration and some surgeons proposed bilateral neck exploration to be (once again) the gold standard operation for primary hyperparathyroidism in 2020s. METHODS A departmental database was used to identify patients who had MIP after concordant dual localisation with sestamibi scintigraphy and ultrasound scans. Long-term follow-up data were obtained from electronic patient records to ascertain any further treatment for recurrent disease and confirm most recent biochemical status. Patients with negative localisation scans and those with familial disease were excluded from analysis. RESULTS Between June 2001 and August 2014 a total of 404 patients (108 M:296F, median age 63 years, range 17-90 years) underwent MIP and had normalisation of calcium in first 6 weeks after the operation. Information on electronic patient records were missing in 14 patients; therefore, data on 390 patients were analysed. During median follow-up of 78 months (IQR: 21.25-111.75 months), 375 patients had normocalcaemia (2.36 mmol/L, IQR: 2.29-2.44 mmol/L) at a median 75 months, (IQR: 20-118 months) after their operation. Overall, 15 (3.85%) patients had biochemical evidence of recurrent disease (2.70 mmol/L IQR: 2.63-2.75 mmol/L) at 92 months (Range: 6-196) after initial operation. Of these, 5 (1.28%) patients underwent a second parathyroid procedure. CONCLUSION Recurrence after scan-directed unilateral neck exploration occurred in 4% of patients after a long disease-free interval. Only one patient had recurrent disease within 1-year of primary surgery. The data suggest that bilateral neck exploration at the time of initial operation, in this selected cohort, is unlikely to have uncovered multi-gland disease and prevent disease recurrence. Focused parathyroidectomy in patients with convincing localisation studies should continue.
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Affiliation(s)
- Neil Patel
- Department of Endocrine Surgery, Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Radu Mihai
- Department of Endocrine Surgery, Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK.
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20
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Minimally Invasive Parathyroidectomy: Can Intraoperative Parathyroid Hormone Monitoring be Omitted? World J Surg 2022; 46:1908-1914. [DOI: 10.1007/s00268-022-06537-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 10/18/2022]
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21
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Yamamoto H, Iima M, Kishimoto Y, Kishimoto AO, Koyasu S, Yamamoto A, Kawai Y, Yoshizawa A, Omori K. Preoperative Localization of Parathyroid Adenomas with Diffusion MR Imaging: Readout-segmented versus Single-shot Echo-planar Imaging. Magn Reson Med Sci 2022; 22:79-85. [PMID: 35249911 PMCID: PMC9849419 DOI: 10.2463/mrms.mp.2021-0149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To evaluate whether readout-segmented echo-planar imaging (RS-EPI) diffusion-weighted imaging (DWI) can reduce image distortion and improve the lesion identification in parathyroid adenomas (PTAs) compared to single-shot EPI (SS-EPI) DWI, and to determine whether PTAs can be differentiated from other soft tissue structures of the head and neck region by using the apparent diffusion coefficient (ADC) value. METHODS We retrospectively analyzed the preoperative MR images including DWI of 24 patients with surgically confirmed PTA. RS-EPI and SS-EPI DWI were evaluated by two independent readers for the identification of the lesions and distortion. The ADC values of the PTAs were compared with those of thyroid glands and cervical lymph nodes. RESULTS RS-EPI provided significantly less distortion compared to SS-EPI. RS-EPI tended to have better lesion identification compared with SS-EPI without a statistically significant difference. On SS-EPI, the PTAs had significantly higher ADC values compared with the cervical lymph nodes. On RS-EPI, the PTAs had significantly higher ADC values compared with the thyroid glands and cervical lymph nodes. CONCLUSION RS-EPI reduces the DWI distortion in PTAs. The ADC value obtained using RS-EPI enables the differentiation of PTAs from nearby structures, such as thyroid glands and cervical lymph nodes.
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Affiliation(s)
- Hirotaka Yamamoto
- Department of Otolaryngology, Shizuoka City Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Mami Iima
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan,Institute for Advancement of Clinical and Translational Science (iACT), Kyoto University Hospital, Kyoto, Kyoto, Japan
| | - Yo Kishimoto
- Department of Otolaryngology Head and Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan,Corresponding author: Department of Otolaryngology Head and Neck Surgery, Graduate School of Medicine, Kyoto University, 54, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto 606-8507, Japan. Phone: +81-75-751-3346, Fax: +81-75-751-7225, E-mail:
| | - Ayami Ohno Kishimoto
- Institute for Advancement of Clinical and Translational Science (iACT), Kyoto University Hospital, Kyoto, Kyoto, Japan
| | - Sho Koyasu
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Akira Yamamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Yoshitaka Kawai
- Department of Otolaryngology Head and Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Akira Yoshizawa
- Department of Otolaryngology Head and Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Koichi Omori
- Department of Otolaryngology Head and Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
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Ramalho D, Rocha G, Oliveira JM, Oliveira MJ. Fluorine-18 Fluorocholine Positron Emission Tomography/Computed Tomography in Primary Hyperparathyroidism: A Case Report and Review of Literature. Cureus 2022; 14:e21958. [PMID: 35282562 PMCID: PMC8904034 DOI: 10.7759/cureus.21958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2022] [Indexed: 11/25/2022] Open
Abstract
Positron emission tomography (PET) tracers (Fluorine-18 Fluorocholine [18F-Fluorocholine] and Carbon-11 Choline [11C-Choline]) have been widely used with promising accuracy in detecting abnormal parathyroids, being crucial for an effective and safe minimally invasive parathyroidectomy. We report a case of a 72-year-old woman with a long-term personal history of osteoporosis and recurrent nephrolithiasis with the need for invasive interventions. Primary hyperparathyroidism was biochemically assumed, although localization of the hyperfunctioning parathyroid had been challenging since cervical ultrasound and technetium-99m sestamibi scintigraphy were negative/equivocal. An 18F-Fluorocholine positron emission tomography/computed tomography (PET/CT) was performed, having identified a small cervical nodule with increased tracer uptake, compatible with a right parathyroid adenoma. After its removal, the patient went into clinical and biochemical remission. 18F-Fluorocholine PET/CT allowed an effective and safe parathyroidectomy as conventional imaging modalities were inaccurate in detecting the abnormal parathyroid, in this patient with serious hyperparathyroidism-related complications.
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23
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Hope TA, Graves CE, Calais J, Ehman EC, Johnson GB, Thompson D, Aslam M, Duh QY, Gosnell JE, Shen WT, Roman SA, Sosa JA, Kluijfhout WP, Seib CD, Villaneuva-Meyer JE, Pampaloni MH, Suh I. Accuracy of 18F-Fluorocholine PET for the Detection of Parathyroid Adenomas: Prospective Single-Center Study. J Nucl Med 2021; 62:1511-1516. [PMID: 33674400 PMCID: PMC8612343 DOI: 10.2967/jnumed.120.256735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/03/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this prospective study was to determine the correct localization rate (CLR) of 18F-fluorocholine PET for the detection of parathyroid adenomas in comparison to 99mTc-sestamibi imaging. Methods: This was a single-arm prospective trial. Ninety-eight patients with biochemical evidence of primary hyperparathyroidism were imaged before parathyroidectomy using 18F-fluorocholine PET/MRI. 99mTc-sestamibi imaging performed separately from the study was evaluated for comparison. The primary endpoint of the study was the CLR on a patient level. Each imaging study was interpreted by 3 masked readers on a per-region basis. Lesions were validated by histopathologic analysis of surgical specimens. Results: Of the 98 patients who underwent 18F-fluorocholine PET, 77 subsequently underwent parathyroidectomy and 60 of those had 99mTc-sestamibi imaging. For 18F-fluorocholine PET in patients who underwent parathyroidectomy, the CLR based on the masked reader consensus was 75% (95% CI, 0.63-0.82). In patients who underwent surgery and had an available 99mTc-sestamibi study, the CLR increased from 17% (95% CI, 0.10-0.27) for 99mTc-sestamibi imaging to 70% (95% CI, 0.59-0.79) for 18F-fluorocholine PET. Conclusion: In this prospective study using masked readers, the CLR for 18F-fluorocholine PET was 75%. In patients with a paired 99mTc-sestamibi study, the use of 18F-fluorocholine PET increased the CLR from 17% to 70%. 18F-fluorocholine PET is a superior imaging modality for the localization of parathyroid adenomas.
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Affiliation(s)
- Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
- Department of Radiology, San Francisco VA Medical Center, San Francisco, California
| | - Claire E Graves
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Eric C Ehman
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Geoffrey B Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
- The Department of Immunology, Mayo Clinic, Rochester, Minnesota
| | - Daniel Thompson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Maya Aslam
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Quan-Yang Duh
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Jessica E Gosnell
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Wen T Shen
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Sanziana A Roman
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Julie A Sosa
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Wouter P Kluijfhout
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carolyn D Seib
- Department of Surgery, Stanford University, Stanford, California; and
| | - Javier E Villaneuva-Meyer
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Miguel H Pampaloni
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Insoo Suh
- Department of Surgery, University of California San Francisco, San Francisco, California;
- Department of Surgery, New York University Langone Health, New York, New York
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24
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Dynamic 18F-fluorocholine PET/CT for parathyroid imaging in patients with primary hyperparathyroidism. Nucl Med Commun 2021; 41:776-782. [PMID: 32453204 DOI: 10.1097/mnm.0000000000001217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In the past few years, F-fluorocholine PET/CT has been established as a promising imaging technique for preoperative localization of parathyroid adenomas, but the optimal time point to start PET/CT acquisition after tracer injection is yet unknown. The aim of the present study was to assess the optimal time frame to acquire the PET/CT images and to evaluate the ability of dynamic imaging to differentiate parathyroid adenomas from active lymph nodes, a common cause for false-positive scan results. PATIENTS AND METHODS Patients with primary hyperparathyroidism who had undergone a dynamic F-fluorocholine PET/CT positive for parathyroid disease and who subsequently underwent successful parathyroidectomy were retrospectively included in this study. On the 20 minutes dynamic images, standardized uptake value measurements were acquired per 1 minute frame for the parathyroid adenoma, the thyroid gland, blood pool activity, and, if present, lymph node activity. RESULTS A total of 101 patients were included in this study. Time-activity curves showed a decrease of activity in parathyroid and thyroid glands, with faster wash-out from the thyroid gland and on average a stable, lower activity in lymph nodes. Blood pool activity was particularly present in the first 2 minutes. Differentiation of a parathyroid adenoma from active lymph nodes was best before 5 minutes, but no definitive cutoff value could be determined. Differentiation of a parathyroid adenoma from the thyroid gland was best after 10 minutes. CONCLUSION Dynamic imaging starting at the early time point of 2 minutes after injection of F-fluorocholine is useful for characterization of hyperfunctioning parathyroid glands.
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Smaxwil C, Aschoff P, Reischl G, Busch M, Wagner J, Altmeier J, Ploner O, Zielke A. [ 18F]fluoro-ethylcholine-PET Plus 4D-CT (FEC-PET-CT): A Break-Through Tool to Localize the "Negative" Parathyroid Adenoma. One Year Follow Up Results Involving 170 Patients. J Clin Med 2021; 10:jcm10081648. [PMID: 33924371 PMCID: PMC8068905 DOI: 10.3390/jcm10081648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/16/2021] [Accepted: 03/25/2021] [Indexed: 12/18/2022] Open
Abstract
Background: The diagnostic performance of [18F]fluoro-ethylcholine-PET-CT&4D-CT (FEC-PET&4D-CT) to identify parathyroid adenomas (PA) was analyzed when ultrasound (US) or MIBI-Scan (MS) failed to localize. Postsurgical one year follow-up data are presented. Methods: Patients in whom US and MS delivered either incongruent or entirely negative findings were subjected to FEC-PET&4D-CT and cases from July 2017 to June 2020 were analyzed, retrospectively. Cervical exploration with intraoperative PTH-monitoring (IO-PTH) was performed. Imaging results were correlated to intraoperative findings, and short term and one year postoperative follow-up data. Results: From July 2017 to June 2020 in 171 FEC-PET&4D-CTs 159 (92.9%) PAs were suggested. 147 patients already had surgery, FEC-PET&4D-CT accurately localized in 141; false neg. 4, false pos. 2, global sensitivity 0.97; accuracy 0.96, PPV 0.99. All of the 117 patients that already have completed their 12-month postoperative follow up had normal biochemical parameter, i.e., no signs of persisting disease. However, two cases may have a potential for recurrent disease, for a cure rate of at least 98.3%. Conclusion: FEC-PET&4D-CT shows unprecedented results regarding the accuracy localizing PAs. The one-year-follow-up data demonstrate a high cure rate. We, therefore, suggest FEC-PET-CT as the relevant diagnostic tool for the localization of PAs when US fails to localize PA, especially after previous surgery to the neck.
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Affiliation(s)
- Constantin Smaxwil
- Department of Endocrine Surgery, Endokrines Zentrum Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany; (M.B.); (J.W.); (J.A.); (A.Z.)
- Correspondence: ; Tel.: +49-711-9913301; Fax: +49-711-9913309
| | - Philip Aschoff
- Department of Nuclear Medicine and PET-CT Centre, Institute of Diagnostic and Interventional Radiology, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany;
| | - Gerald Reischl
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University of Tuebingen, 72076 Tuebingen, Germany;
- Cluster of Excellence iFIT (EXC 2180) Image Guided and Functionally Instructed Tumor Therapies, University of Tuebingen, 72076 Tuebingen, Germany
| | - Mirjam Busch
- Department of Endocrine Surgery, Endokrines Zentrum Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany; (M.B.); (J.W.); (J.A.); (A.Z.)
| | - Joachim Wagner
- Department of Endocrine Surgery, Endokrines Zentrum Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany; (M.B.); (J.W.); (J.A.); (A.Z.)
| | - Julia Altmeier
- Department of Endocrine Surgery, Endokrines Zentrum Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany; (M.B.); (J.W.); (J.A.); (A.Z.)
| | - Oswald Ploner
- Department of Internal Medicine, Endocrinology, Endokrines Zentrum Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany;
| | - Andreas Zielke
- Department of Endocrine Surgery, Endokrines Zentrum Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany; (M.B.); (J.W.); (J.A.); (A.Z.)
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26
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Soylu L, Aydın OU, Ilgan S, Özbaş S, Bilezikçi B, Gürsoy A, Koçak S. Radioguided occult lesion localization for minimally-invasive parathyroidectomy without quick PTH monitoring and frozen section: impact of the learning curve. Turk J Surg 2021; 36:297-302. [PMID: 33778386 DOI: 10.47717/turkjsurg.2020.4470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 04/24/2020] [Indexed: 11/23/2022]
Abstract
Objectives Minimally-invasive parathyroidectomy (MIP) is a surgical procedure that reduces the duration of operation, hospital costs, and hypocalcemia, and shortens the length of hospital stay. This study addressed the important procedural details of the radioguided occult lesion localization (ROLL)-MIP technique and evaluated the consequences of the learning curve from a series of patients. Patients and Methods A total of 80 patients who underwent ROLL-MIP for a single parathyroid adenoma were included into this retrospective study. In order to analyze the effect of the learning curve, these subjects were then divided into 2 groups per time period and the operative times were compared. Group A consisted of 22 previously reported patients who served as the control group. Group B consisted of 58 consecutive patients. Results Serum calcium and parathyroid hormone (PTH) levels were normalized in all of the patients within 2 days and remained normal during the follow-up period (31 ± 18.5 months). None of the patients who underwent ROLL-guided parathyroidectomy suffered temporary or permanent recurrent laryngeal nerve injuries. Mean operation time (time from incision to excision of the adenoma) was 23 ± 6 min in Group A and 18 ± 7 min in Group B. Mean operative times were significantly shorter in group B. Conclusion The success of MIP administered with the ROLL technique in a single adenomatous patient was quite high. This method seems especially valuable in patients with atypically located or small adenomas.
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Affiliation(s)
- Lütfi Soylu
- Ankara Güven Hastanesi , Endokrin Cerrahi , Ankara, Turkey
| | | | | | - Serdar Özbaş
- Ankara Güven Hastanesi , Endokrin Cerrahi , Ankara, Turkey
| | | | | | - Savaş Koçak
- Ankara Güven Hastanesi , Endokrin Cerrahi , Ankara, Turkey
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27
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Serradilla-Martín M, Palomares-Cano A, Cantalejo-Díaz M, Mogollón-González M, Brea-Gómez E, Muñoz-Pérez NV, Arcelus-Martínez JI, Villar-Del-Moral JM. Usefulness of the Wisconsin and CaPTHUS indices for predicting multiglandular disease in patients with primary hyperparathyroidism in a southern European population. Gland Surg 2021; 10:861-869. [PMID: 33842231 DOI: 10.21037/gs-20-857] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Focused parathyroidectomy is a safe technique for the treatment of primary hyperparathyroidism. The CaPTHUS score and the Wisconsin index are preoperative diagnostic tools designed to distinguish between single- and multigland disease. The aim of the study is to evaluate the usefulness of these models for predicting multiglandular disease in a European population. Methods Retrospective review of a database of patients operated upon for primary hyperparathyroidism at a referral center. The sensitivity, specificity, positive and negative predictive values, and reliability of both scores for the prediction of multiglandular disease, were calculated. Receiver operating characteristic (ROC) curves were constructed to assess the sensitivity and specificity of CaPTHUS score and Wisconsin Index for predicting single-gland disease. A level of P<0.05 was accepted as significant. Results Two hundred and eighty-one patients who underwent successful surgery from January 2001 to December 2018 were included. Single-gland disease was detected in 92.5%, and 73.7% had a CaPTHUS score of ≥3. The sensitivity, specificity, positive and negative predictive values of this model for predicting single-gland disease with a score of ≥3 were 76.9%, 66.7%, 96.6%, and 18.9% respectively. The area under the curve value of the CaPTHUS score for predicting single-gland disease was 0.74. A Wisconsin Index >2,000 and an excised gland weight above one gram presented a positive predictive value for single-gland disease of 92.5%. Conclusions Despite the good performance of both scales, the established cut-off points did not definitively rule out parathyroid multiglandular disease in our population. In cases with a minimal suspicion of this condition, additional intraoperative techniques must be used, or bilateral neck explorations should be performed.
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Affiliation(s)
- Mario Serradilla-Martín
- Instituto de Investigación Sanitaria Aragón, Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Ana Palomares-Cano
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | | | | | - Esther Brea-Gómez
- Department of Surgery, Virgen de las Nieves University Hospital, Granada, Spain
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Shawky MS, Sakr MF, Nabawi AS, Abdel-Aziz TE, De Jong MC, García VR, Lam F, Soromani C, Smart J, Honour JW, Kurzawinski TR. Influence of common clinical variables on intraoperative parathyroid hormone monitoring during surgery for primary hyperparathyroidism. J Endocrinol Invest 2020; 43:1205-1212. [PMID: 32124267 DOI: 10.1007/s40618-020-01201-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/17/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Intraoperative monitoring of parathyroid hormone (IOPTH) is a reliable method of predicting the cure of primary hyperparathyroidism (PHPT). The aim of this study is to assess whether common clinical variables (CCV) frequently encountered in patients with PHPT may affect the magnitude of PTH drop or the likelihood of patients meeting the intraoperative cure criterion. DESIGN Patients who were surgically cured from PHPT caused by single gland disease (SGD) and had full IOPTH protocol (4 measurements) were stratified according to age, gland weight, renal function, vitamin D status and severity of hypercalcemia. The percentage of IOPTH drop and the frequency of patients who had true positive IOPTH test results were compared among groups. RESULTS 762 patients had surgery for PHPT, of whom 746 were (98%) cured. Of these 746 patients, 511 who had SGD and a full IOPTH protocol were included in this study. The median IOPTH drop was significantly higher among younger patients, those with severe hypercalcaemia at 5, 10, 15 min after gland excision, giant glands (at 5-min only), patients with vitamin D deficiency (at 10, 15 min), and those with normal renal function (at 15 min only). The likelihood of the patients meeting the intraoperative cure criterion was not significantly affected among the groups except in patients with mild hypercalcaemia, who were significantly less likely to have 50% IOPTH drop than those with severe hypercalcaemia at all time points. The frequency of mildly hypercalcaemic patients who met cure criterion was significantly improved by extending measurement to 15 min. CONCLUSIONS IOPTH monitoring has the ability to mitigate the variability of IOPTH kinetics associated with most clinical variables. Mildly hypercalcemic patients in particular may benefit from waiting for 15-min measurement before any surgical decision is made.
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Affiliation(s)
- M S Shawky
- Centre for Endocrine Surgery, University College London Hospital and London Clinic, 250 Euston Road, London, NW1 2PG, UK.
- Department of General Surgery, Alexandria University, Alexandria, Egypt.
| | - M F Sakr
- Department of General Surgery, Alexandria University, Alexandria, Egypt
| | - A S Nabawi
- Department of General Surgery, Alexandria University, Alexandria, Egypt
| | - T E Abdel-Aziz
- Centre for Endocrine Surgery, University College London Hospital and London Clinic, 250 Euston Road, London, NW1 2PG, UK
- Department of General Surgery, Alexandria University, Alexandria, Egypt
| | - M C De Jong
- Centre for Endocrine Surgery, University College London Hospital and London Clinic, 250 Euston Road, London, NW1 2PG, UK
| | - V Rozalén García
- Centre for Endocrine Surgery, University College London Hospital and London Clinic, 250 Euston Road, London, NW1 2PG, UK
| | - F Lam
- Department of Clinical Biochemistry, University College London Hospital, London, UK
| | - C Soromani
- Department of Clinical Biochemistry, University College London Hospital, London, UK
| | - J Smart
- Department of Anaesthesia, University College London Hospital, London, UK
| | - J W Honour
- Department of Clinical Biochemistry, University College London Hospital, London, UK
| | - T R Kurzawinski
- Centre for Endocrine Surgery, University College London Hospital and London Clinic, 250 Euston Road, London, NW1 2PG, UK
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Fatima T, Das B, Sattar S, Jabeen S, Khan AA, Islam N. The Utility of Ultrasound in the Preoperative Localization of Primary Hyperparathyroidism: Insights from Pakistan. Cureus 2020; 12:e9835. [PMID: 32953342 PMCID: PMC7496491 DOI: 10.7759/cureus.9835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective We aimed to evaluate and compare the diagnostic performance of ultrasound (US) and 99m-Tc sestamibi scintigraphy for the preoperative localization of primary hyperparathyroidism (PHPT). Methods This retrospective study was conducted at the Aga Khan University Hospital in Karachi, Pakistan, and comprised the data of patients with PHPT who underwent parathyroidectomy from 2008 to 2017. Preoperative US and 99m-Tc sestamibi scintigraphy findings were recorded and compared to surgical and histological findings, which were taken as a reference standard. Results The sensitivity of US in the preoperative localization of PHPT was 88.3%, positive predictive value (PPV) was 94.6%, and accuracy was 84.1%. The sensitivity of 99m-Tc sestamibi scintigraphy was 90.4%, PPV was 94.3%, and accuracy was 85.7%. Conclusion US neck is an efficient tool for the preoperative localization of PHPT, demonstrating a comparable diagnostic yield with 99m-Tc sestamibi, and can serve as a credible first-line imaging modality in a resource-constrained healthcare setup.
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30
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Kota SK, Kota SK, Jammula S, Bhargav PRK, Sahoo AK, Das S, Talluri SC, Kongara S, S Krishna SV, Modi KD. Persistent Elevation of Parathormone Levels after Surgery for Primary Hyperparathyroidism. Indian J Endocrinol Metab 2020; 24:366-372. [PMID: 33088762 PMCID: PMC7540826 DOI: 10.4103/ijem.ijem_212_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/06/2020] [Accepted: 07/04/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Persistent elevation of serum parathyroid hormone (PTH) despite normocalcemia have been documented in 8- 40% of patients after parathyroidectomy. We hereby report our experience from different centers across India to determine clinical significance of postoperatively elevated PTH levels and review relevant literature. METHODS We conducted a retrospective case series study and reviewed all the patients who underwent surgery for primary hyperparathyroidism (PHPT) from April 2010 to January 2020. RESULTS Total of 201 patients was diagnosed as PHPT. Out of available follow-up data of 180 patients, a total of 54 patients (30%) had persistently elevated PTH (PePTH) at 1 month. Patients with PePTH were older with higher preoperative serum calcium, iPTH, alkaline phosphatase and lower serum phosphate and 25-hydroxy vitamin D3 levels. Creatinine clearance was found to be significantly lower in patients with PePTH. Multiple linear regression analysis revealed that preoperative 25-OH D3 concentration, creatinine clearance and iPTH are the factors influencing persistent elevation of PTH levels. Significantly lower serum calcium and higher alkaline phosphatase levels were observed in PePTH patients with preoperative 25-OH D3 levels <20 ng/mL. Thirty patients at 6 months, 24 patients at 1 year, 18 patients at 2 years and 9 patients at 3 years had eucalcemic PTH elevation. Nine out of 126 (7%) patients with normal initial postoperative calcium and iPTH levels developed PePTH, with none culminating into recurrent hyperparathyroidism. CONCLUSION Though the pathogenesis of such a phenomenon still remains to be elucidated, a multifactorial mechanism appears to play a role.
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Affiliation(s)
- Sunil K. Kota
- Endocrinology, DIABETES and ENDOCARE Clinic, Berhampur, Odisha, India
| | | | - Sruti Jammula
- Pharmaceutics, Roland Institute of Pharmaceutical Sciences, Berhampur, Odisha, India
| | - P R K Bhargav
- Endocrine Surgery, Endocare Hospital, Vijayawada, Andhra Pradesh, India
| | - Abhay K. Sahoo
- Endocrinology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Sambit Das
- Endocrinology, Hi Tech Medical College, Bhubaneswar, Odisha, India
| | | | | | - S V S Krishna
- Endocrinology, Military Hospital, Secunderabad, Telangana, India
| | - K D Modi
- Endocrinology, CARE Hospital, Nampally, Hyderabad, Telangana, India
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Intraoperative Adjunct Methods for Localization in Primary Hyperparathyroidism. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 53:84-95. [PMID: 32377064 PMCID: PMC7199831 DOI: 10.14744/semb.2019.37542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 12/16/2022]
Abstract
Primary hyperparathyroidism (pHPT) is a frequently seen endocrine disease, and its main treatment is surgery. In the majority of pHPT, the disease involves only a single gland, and the majority of the pathological glands can be determined by preoperative localization methods.In addition to preoperative localization studies in parathyroidectomy, the use of adjunct methods to improve intraoperative localization in order to increase success of surgery is becoming widespread. These methods include different approaches, mainly intraoperative parathyroid hormone (PTH) measurement, followed by intraoperative gamma probe application, intraoperative ultrasonography, parathyroid imaging with methylene blue, and frozen section examination. Recently, especially promising new imaging methods have been described in the literature with various optical technologies to increase the localization of the parathyroid glands and to evaluate their viability. These methods include parathyroid imaging with autofluorescence, indocyanine green imaging with autofluorescence, autofluorescence imaging with methylene blue, autofluorescence imaging with 5-aminolevulinic acid, optical coherence tomography, laser speckle contrast imaging, dynamic optical contrast imaging, and Raman spectroscopy. Currently, minimally invasive parathyroidectomy has become the standard treatment for selected pHPT patients with the aid of preoperative imaging and intraoperative auxiliary methods . The aim of the present study was to evaluate the routinely used new promising intraoperative adjunct methods in pHPT.
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Vijayasarathi A, Karnezis S, Azizyan A, Salamon N, Sepahdari A. 4D CT Parathyroid for the General Radiologist: A Pictorial Essay of Illustrative Cases. Curr Probl Diagn Radiol 2020; 51:659-665. [DOI: 10.1067/j.cpradiol.2020.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/06/2020] [Accepted: 02/25/2020] [Indexed: 11/22/2022]
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Acar N, Haciyanli M, Coskun M, Erdogan NK, Celik SC, Haciyanli SG, Gur EO. Diagnostic value of four-dimensional computed tomography and four-dimensional magnetic resonance imaging in primary hyperparathyroidism when first-line imaging was inadequate. Ann R Coll Surg Engl 2020; 102:294-299. [PMID: 31918555 DOI: 10.1308/rcsann.2019.0182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Accurate localisation of the abnormal hyperfunctioning gland with preoperative imaging has a critical role in parathyroid surgery to obtain a successful outcome. This study aimed to evaluate the diagnostic performance of second-line imaging and their contribution to the treatment success in primary hyperparathyroidism when the first-line methods were negative or discordant. METHODS Among the patients who underwent parathyroidectomy due to primary hyperparathyroidism, 33 who underwent four-dimensional computed tomography and/or four-dimensional magnetic resonance imaging because of negative or discordant first-line imaging results were included. Persistent and recurrent cases were excluded. RESULTS The majority of the patients were female (84.8%) and the mean age was 59.2 years. Seventeen patients had four-dimensional computed tomography and 25 had four-dimensional magnetic resonance imaging, respectively. Four-dimensional computed tomography and four-dimensional magnetic resonance imaging localised the culprit gland successfully in 52.9% and 84%, respectively. Twenty-five patients in whom single adenoma was detected underwent focused parathyroidectomy. The culprit gland was solitary in 32 cases and one patient had double adenoma. Normocalcaemia was achieved in all cases. Among the 29 patients who completed their postoperative sixth month success rate was 100%. CONCLUSION Four-dimensional magnetic resonance imaging had high accuracy with fast dynamic imaging in detecting parathyroid adenomas. When the first-line imaging methods were negative or inconclusive, four-dimensional magnetic resonance imaging should be considered primarily since it is cost effective in Turkey and emits no radiation.
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Affiliation(s)
- N Acar
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - M Haciyanli
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - M Coskun
- Department of Radiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - N K Erdogan
- Department of Radiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - S C Celik
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - S G Haciyanli
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - E O Gur
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
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Gannagé-Yared MH, Younès N, Azzi AS, Sleilaty G. Comparison between Second- and Third-Generation PTH Assays during Minimally Invasive Parathyroidectomy (MIP). Int J Endocrinol 2020; 2020:5230985. [PMID: 32256573 PMCID: PMC7102406 DOI: 10.1155/2020/5230985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/22/2020] [Accepted: 02/18/2020] [Indexed: 11/19/2022] Open
Abstract
METHODS 112 patients (of which 72.3% females) underwent MIP by the same surgeon. Age, sex, body mass index (BMI), pre- and postoperative serum calcium, creatinine, 25(OH)D levels, PTH at baseline (PTH T0), and PTH at 10 minutes after adenoma resection (PTH T10) were recorded. Both PTH 2G and PTH 3G assays were assessed using the Diasorin assays. RESULTS The mean age was 56.1 ± 14.7 years. Mean value of BMI, preoperative calcium, 25(OH)D, and CKD-EPI-eGFR were, respectively, 26.8 ± 4.8 kg/m2, 110.9 ± 7.9 mg/L, 19.3 ± 9.2 ng/mL, and 88.6 ± 25.6 mL/min/1.73 m2. PTH 2G and PTH 3G assays were well correlated at PTH T0 and PTH T10 (respectively, correlation coefficient 0.74 and 0.72 for intraclass correlation type 3). The median PTH fall was, respectively, of 79.9% and 82.5% for PTH 2G and PTH 3G. Multivariate analysis using the combined PTH 2G and PTH 3G as a dependent variable with 2 repeated measurements (at PTH 0 and PTH 10) showed a significant effect of preoperative calcium on IOPTH fall (p=0.001, effect size 0.13), while no significant effects were observed for sex, age, BMI, and 25(OH)D. CONCLUSION PTH 2G and PTH 3G assays resulted in a similar drop in IOPTH values. Elevated preoperative calcium levels are the only independent predictor of IOPTH decline. Further studies are needed to determine other factors that can influence PTH kinetics.
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Affiliation(s)
| | - Nada Younès
- Endocrinology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Anne-Sophie Azzi
- Endocrinology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Ghassan Sleilaty
- Department of Biostatistics, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Clinical Research Center, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
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The Reasons of Eucalcemic Parathyroid Hormone Elevation After Parathyroidectomy for Sporadic Primary Hyperparathyroidism. Indian J Surg 2019. [DOI: 10.1007/s12262-019-01864-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Khan ZF, Lew JI. Intraoperative Parathyroid Hormone Monitoring in the Surgical Management of Sporadic Primary Hyperparathyroidism. Endocrinol Metab (Seoul) 2019; 34:327-339. [PMID: 31884732 PMCID: PMC6935782 DOI: 10.3803/enm.2019.34.4.327] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/01/2019] [Accepted: 12/04/2019] [Indexed: 01/28/2023] Open
Abstract
Intraoperative parathyroid hormone monitoring (IPM) has been shown to be a useful adjunct during parathyroidectomy to ensure operative success at many specialized medical centers worldwide. Using the Miami or ">50% intraoperative PTH drop" criterion, IPM confirms the complete excision of all hyperfunctioning parathyroid tissue before the operation is finished, and helps guide the surgeon to identify additional hyperfunctioning parathyroid glands that may necessitate further extensive neck exploration when intraoperative parathyroid hormone (PTH) levels do not drop sufficiently. The intraoperative PTH assay is also used to differentiate parathyroid from non-parathyroid tissues during operations using fine needle aspiration samples and to lateralize the side of the neck harboring the hypersecreting parathyroid through differential jugular venous sampling when preoperative localization studies are negative or equivocal. The use of IPM underscores the recognition and understanding of sporadic primary hyperparathyroidism (SPHPT) as a disease of function rather than form, where the surgeon is better equipped to treat such patients with quantitative instead of qualitative information for durable long-term operative success. There has been a significant paradigm shift over the last 2 decades from conventional to focused parathyroidectomy guided by IPM. This approach has proven to be a safe and rapid operation requiring minimal dissection performed in an ambulatory setting for the treatment of SPHPT.
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Affiliation(s)
- Zahra F Khan
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - John I Lew
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
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Caldwell M, Laux J, Clark M, Kim L, Rubin J. Persistently Elevated PTH After Parathyroidectomy at One Year: Experience in a Tertiary Referral Center. J Clin Endocrinol Metab 2019; 104:4473-4480. [PMID: 31188435 PMCID: PMC6736213 DOI: 10.1210/jc.2019-00705] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/06/2019] [Indexed: 12/24/2022]
Abstract
CONTEXT/OBJECTIVE Increased PTH after successful parathyroid surgery represents a clinical conundrum. We aimed to determine the prevalence of persistently elevated PTH (PePTH) postsurgery, along with predisposing factors. DESIGN and Setting: Patients ≥ age 18 with parathyroidectomy performed at University of North Carolina Hospitals for primary hyperparathyroidism (PHPT) over a 12-year period were identified from the Carolina Data Warehouse. Clinical and demographic characteristics were collected, transformed, and analyzed. RESULTS Five hundred seventy patients met initial criteria for PHPT, and of those 407 had postoperative values. One hundred forty-four had laboratory results within 3 to 18 months post operatively. There was no clinical difference between those with and without long-term laboratory follow-up. Presurgery, patients had average calcium of 11 mg/dL and PTH 125.4 pg/mL. Ninety-seven percent of patients had normalized calcium after surgery, but 30% had PePTH, which can be predicted at 3 months. Patients with PePTH (persistent elevation of PTH) after surgery did not differ from those with normalized PTH in terms of sex, age, body mass index, or excised gland weight; presurgery 25-vitamin D was slightly lower, but not abnormal (26 ± 15 vs 36 ± 11). The presurgical PTH was significantly higher (P < 0.001) in those with PePTH (156.5 pg/mL compared with presurgical level of 102.5 in those whose PTH normalized). CONCLUSIONS Nearly one-third of PHPT patients have elevated PTH levels postsurgery in a tertiary hospital setting. At presentation, patients with PePTH tend to have higher PTH relative to calcium levels. Whether PePTH after surgical treatment of PHPT has pathological consequences is unknown.
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Affiliation(s)
- Marie Caldwell
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Jeff Laux
- NC TraCS Institute, University of North Carolina, Chapel Hill, North Carolina
| | - Marshall Clark
- NC TraCS Institute, University of North Carolina, Chapel Hill, North Carolina
| | - Lawrence Kim
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Janet Rubin
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
- Correspondence and Reprint Requests: Janet Rubin, MD, Department of Medicine, University of North Carolina, CB# 7170, Chapel Hill, North Carolina 27599. E-mail:
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Broos WAM, Wondergem M, Knol RJJ, van der Zant FM. Parathyroid imaging with 18F-fluorocholine PET/CT as a first-line imaging modality in primary hyperparathyroidism: a retrospective cohort study. EJNMMI Res 2019; 9:72. [PMID: 31367807 PMCID: PMC6669225 DOI: 10.1186/s13550-019-0544-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/23/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND 18F-fluorocholine (FCH) PET/CT is a promising technique for visualizing hyperfunctioning parathyroid glands in hyperparathyroidism. It is still under debate whether to use this technique as a first-line imaging modality or to use it when conventional techniques such as 99mTc-sestamibi scintigraphy or ultrasonography are inconclusive. This study evaluates FCH PET/CT as a first-line modality. METHODS Patients with primary hyperparathyroidism, referred between June 2015 and December 2018 for FCH PET/CT as a first-line imaging method, were included in this study. Baseline characteristics, clinical data, scan results, and type of treatment were recorded. The rate of correct detection was calculated on a per patient-based and a per lesion-based analysis. The reference standard comprised histopathological results, intraoperative response to parathyroidectomy, and clinical follow-up. RESULTS Two hundred and seventy-one patients were included, of which 139 patients underwent parathyroidectomy, 48 were treated with calcimimetics, and 84 patients received further follow-up without active treatment. In the surgically treated group, a single adenoma was suspected in 127 scans, double adenoma in three scans, and one scan showed evidence of three hyperfunctioning glands. In eight scans, no lesions were visualized. A total of 154 parathyroid glands were surgically removed. The rate of correct detection was calculated at 96% and 90%, on a per patient-based and per lesion-based analysis, respectively. CONCLUSION This retrospective study in a large cohort shows high detection rates of FCH PET/CT in primary hyperparathyroidism, which is in accordance to literature. The use of FCH PET/CT as a first-line imaging modality in preoperative planning of parathyroid surgery may therefore be a suitable choice.
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Affiliation(s)
- Wouter A M Broos
- Department of Nuclear Medicine, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
| | - Maurits Wondergem
- Department of Nuclear Medicine, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - Remco J J Knol
- Department of Nuclear Medicine, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - Friso M van der Zant
- Department of Nuclear Medicine, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
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Detecting Synchronous Thyroid Adenoma and False-Positive Findings on Technetium-99m MIBI Single Photon-Emission Computed Tomography/Computed Tomography. Diagnostics (Basel) 2019; 9:diagnostics9020057. [PMID: 31159406 PMCID: PMC6627855 DOI: 10.3390/diagnostics9020057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 11/17/2022] Open
Abstract
Technetium (Tc)-99m-methoxyisobutylisonitrile (MIBI) single photon-emission computed tomography/computed tomography (SPECT/CT) is now being used increasingly for preoperative localization of parathyroid adenomas. Tc-99m-MIBI scintigraphy in a 52-year-old man with a diagnosis of primary hyperparathyroidism revealed two focal areas with retention of radioactivity in the left lobe of the thyroid gland on the delayed phase of MIBI SPECT/CT but no significant focal radioactive uptake on MIBI planar images. The patient subsequently underwent left partial parathyroidectomy. Histological analysis identified one lesion to be thyroid hyperplasia and the other to be parathyroid adenoma. This case demonstrates the value of MIBI SPECT/CT for localization of a parathyroid lesion when compared with planar images and that false-positive findings can lead to misdiagnosis in a patient with coexisting thyroid disease. An appropriate diagnostic work-up that includes Tc-99m MIBI SPECT/CT in addition to ultrasonography is helpful for an accurate diagnosis in patients with concomitant thyroid disease.
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Schneider R, Hinrichs J, Meier B, Walz MK, Alesina PF. Minimally Invasive Parathyroidectomy without Intraoperative PTH Performed after Positive Ultrasonography as the only Diagnostic Method in Patients with Primary Hyperparathyroidism. World J Surg 2019; 43:1525-1531. [DOI: 10.1007/s00268-019-04944-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
One of the most promising imaging techniques in primary hyperparathyroidism is PET/CT with choline-based tracers. To investigate the current evidence of these tracers in localizing parathyroid adenoma, a systematic review was performed. A comprehensive literature search was carried out and eligible studies were analyzed. Data were extracted, the level of evidence was scored, and performance data were pooled to calculate the weighted detection rate. Eleven articles were included in this study. The pooled detection rate was 97 and 94% on per patient-based and per lesion-based analysis, respectively. There was considerable heterogeneity between studies and the level of evidence was determined to be 3a-, following Oxford criteria. Choline PET/CT has shown favorable results in detection of hyperfunctioning parathyroid tissue and may replace conventional technetium-99m-sestamibi scintigraphy in preoperative planning of parathyroid surgery. However, the quality of current evidence is moderate, and additional high-quality studies are needed to confirm these numbers.
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Shawky M, Abdel Aziz T, Morley S, Beale T, Bomanji J, Soromani C, Lam F, Philips I, Matias M, Honour J, Smart J, Kurzawinski TR. Impact of intraoperative parathyroid hormone monitoring on the management of patients with primary hyperparathyroidism. Clin Endocrinol (Oxf) 2019; 90:277-284. [PMID: 30346646 DOI: 10.1111/cen.13882] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/14/2018] [Accepted: 10/16/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND/OBJECTIVE Intraoperative parathyroid hormone (IOPTH) monitoring during surgery for primary hyperparathyroidism (PHPT) could improve cure rate and simplify current care pathways. This study assesses the performance of US, MIBI and IOPTH monitoring and their impact on outcomes and perioperative strategy. DESIGN This is a retrospective study of a prospectively maintained database of patients who underwent parathyroidectomy guided by preoperative US, MIBI and IOPTH monitoring. Test performance (sensitivity, specificity, PPV, NPV, accuracy) and IOPTH added value (percentage of patients in whom test contributed to achieving cure) were calculated. RESULTS A total of 617 patients (median age 59 years, 75% females), 603 (97.7%) of them cured, were included in analysis. Sensitivity of US was higher than MIBI (78.2% vs 70%, P < 0.05), but both were inferior to IOPTH (98.6%, P < 0.05). US and MIBI were more sensitive at detecting single gland disease (SGD) than multigland disease (MGD) (85% vs 55% and 77.5% vs 45.5%, respectively, P < 0.05), while IOPTH performed well in both situations (98.8% vs 96.7%, P > 0.05). In 41 patients with incorrect US predictions, MIBI gave correct result only in 12 (29.3%) cases, while IOPTH gave correct predictions in all but one patient (97.6%). Minimally invasive parathyroidectomy (MIP) was completed in 409 patients, with a similar completion rate regardless whether both or one scan was positive. IOPTH added value was significant in whole cohort (14%) and in subgroups of patients with concordant vs discordant scans, minimally invasive vs conventional surgery, and initial vs reoperative surgery. CONCLUSIONS Intraoperative parathyroid hormone monitoring is more accurate at predicting cure than US and MIBI are at identifying abnormal glands in patients undergoing parathyroidectomy for PHPT and significantly contributes to cure rate in range of clinical scenarios. This implies that its routine use could facilitate successful surgery in patients with single positive imaging and increase number of MIPs while maintaining high cure rate.
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Affiliation(s)
- Michael Shawky
- Centre for Endocrine Surgery, University College London Hospital & London Clinic, London, UK
- Department of General Surgery, Alexandria University, Alexandria, Egypt
| | - Tarek Abdel Aziz
- Centre for Endocrine Surgery, University College London Hospital & London Clinic, London, UK
- Department of General Surgery, Alexandria University, Alexandria, Egypt
| | - Simon Morley
- Department of Radiology, University College London Hospital, London, UK
| | - Timothy Beale
- Department of Radiology, University College London Hospital, London, UK
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospital, London, UK
| | - Christine Soromani
- Department of Clinical Biochemistry, University College London Hospital, London, UK
| | - Francis Lam
- Department of Clinical Biochemistry, University College London Hospital, London, UK
| | - Ian Philips
- Department of Clinical Biochemistry, University College London Hospital, London, UK
| | - Michelle Matias
- Centre for Endocrine Surgery, University College London Hospital & London Clinic, London, UK
| | - John Honour
- Department of Clinical Biochemistry, University College London Hospital, London, UK
| | - Jamie Smart
- Department of Anaesthesia, University College London Hospital, London, UK
| | - Tom R Kurzawinski
- Centre for Endocrine Surgery, University College London Hospital & London Clinic, London, UK
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Scattergood S, Marsden M, Kyrimi E, Ishii H, Doddi S, Sinha P. Combined ultrasound and Sestamibi scintigraphy provides accurate preoperative localisation for patients with primary hyperparathyroidism. Ann R Coll Surg Engl 2019; 101:97-102. [PMID: 30286659 PMCID: PMC6351877 DOI: 10.1308/rcsann.2018.0158] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Minimally invasive parathyroidectomy has advantages over the traditional bilateral neck exploration for the surgical treatment of primary hyperparathyroidism. It requires accurate localisation of the parathyroid pathology prior to surgery. The best method of preoperative localisation in a district general hospital setting is not well understood. METHODS All patients who underwent parathyroidectomy for primary hyperparathyroidism from 2008 to 2016 were identified from a prospectively maintained database. Operative findings were correlated with radiological and histological results. Sensitivity and specificity of ultrasound, sestamibi scintigraphy and the two together were calculated for diagnostic precision and compared. RESULTS One hundred and eighty-four patients met the inclusion criteria, of whom 81.5% had a histological diagnosis of a parathyroid adenoma. Ultrasound had higher sensitivity than sestamibi scintigraphy. Used together, ultrasound and sestamibi scintigraphy performed better than either ultrasound or sestamibi scintigraphy alone (P< 0.001). Twenty-two of 184 cases had no lesion located by either ultrasound or sestamibi scintigraphy preoperatively. Where neither ultrasound nor sestamibi scintigraphy located the lesion, additional computed tomography led to the excision of parathyroid pathology in one in ten patients. CONCLUSION The combination of ultrasound and sestamibi scintigraphy provides the highest sensitivity of preoperative localisation. This approach led to a high success rate of minimally invasive parathyroidectomy. Where preoperative localisation is not achieved with ultrasound or sestamibi scintigraphy, computed tomography adds little additional benefit. In this setting other modalities of localisation such a selective venous sampling, intraoperative methylene blue or intraoperative parathyroid hormone levels could be considered.
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Affiliation(s)
- S Scattergood
- General Surgery Department, Princess Royal University Hospital, Orpington, UK
| | - M Marsden
- Academic Centre of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - E Kyrimi
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK
| | - H Ishii
- ENT department, St George's Hospital, London, UK
| | - S Doddi
- General Surgery Department, Princess Royal University Hospital, Orpington, UK
| | - P Sinha
- General Surgery Department, Princess Royal University Hospital, Orpington, UK
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Khan ZF, Picado O, Marcadis AR, Farrá JC, Lew JI. Additional 20-Minute Intraoperative Parathormone Measurement Can Minimize Unnecessary Bilateral Neck Exploration. J Surg Res 2019; 235:264-269. [PMID: 30691805 DOI: 10.1016/j.jss.2018.08.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/18/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Parathyroidectomy guided by intraoperative parathormone (ioPTH) monitoring for primary hyperparathyroidism (pHPT) confirms removal of all hyperfunctioning parathyroid glands. This study evaluates the utility of an additional 20-min ioPTH measurement in patients who fail to meet the >50% ioPTH drop criterion. METHODS A retrospective review of prospectively collected data of 706 patients with pHPT who underwent parathyroidectomy guided by ioPTH monitoring was performed. When a >50% ioPTH decrease from the highest either preincision or preexcision level was achieved after 10 min, parathyroidectomy was completed. If this criterion was not met, further exploration was performed or an additional 20-min ioPTH measurement was obtained. RESULTS Of 706 patients, 72 (10%) patients did not meet the >50% ioPTH drop criterion at 10 min. Of these patients, 67% (48/72) underwent immediate bilateral neck exploration (BNE). For the other 33% of patients (24/72), a 20-min parathormone (PTH) measurement was drawn. Of patients with an additional 20-min PTH measurement, 46% (11/24) had a >50% ioPTH decrease at 20 min where BNE was avoided and parathyroidectomy completed, whereas 54% (13/24) did not. Compared to patients with insufficient ioPTH drop at 10 min and subsequent BNE, there was a statistically significant 46% reduction of BNE in patients with a 20-min PTH level (P < 0.01). CONCLUSIONS A 20-min ioPTH measurement is useful in preventing unnecessary BNE in some patients who undergo focused parathyroidectomy with a delayed >50% ioPTH drop.
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Affiliation(s)
- Zahra F Khan
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
| | - Omar Picado
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Andrea R Marcadis
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Josefina C Farrá
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - John I Lew
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
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Memeh KO, Palacios JE, Khan R, Guerrero MA. PRE-OPERATIVE LOCALIZATION OF PARATHYROID ADENOMA: PERFORMANCE OF 4D MRI PARATHYROID PROTOCOL. Endocr Pract 2019; 25:361-365. [PMID: 30720353 DOI: 10.4158/ep-2018-0424] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Accurate pre-operative image localization is critical in the selection of minimally invasive parathyroidectomy as a surgical treatment approach in patients with primary hyperparathyroidism (PHPT). Sestamibi scan, ultrasound, computed tomography, and conventional magnetic resonance imaging (MRI) has varying accuracy in localizing parathyroid adenoma (PTA). Our group has previously shown that four-dimensional (4D) MRI is more accurate than conventional imaging in identifying single adenomas. In this study, we set out to determine if it is possible to accurately localize the quadrant of the adenoma using 4D MRI. Methods: We analyzed and matched the quadrants of PTA identified by pre-operative 4D-MRI with the operative findings during parathyroidectomy for PHPT at our institution during the study period. All resections were confirmed to be successful with an adequate decrease in intraoperative parathyroid hormone as defined by the Miami criterion. Results: A total of 26 patients with PHPT underwent pre-operative localization with the 4D MRI parathyroid protocol. Fourteen patients had true single-gland adenoma (SGA) and 12 patients had multi-gland disease (MGD). 4D MRI accurately identified all the SGA. Using this method, we were also able to localize the adenoma in the correct quadrant in 14 of the 18 patients with SGA. All 3 double adenomas were accurately identified using 4D MRI; however, MGD was only accurately identified 67% of the time. The 4D MRI had an overall 85% accuracy in distinguishing SGA from MGD. Conclusion: 4D MRI accurately identified single and double adenomas in their respective quadrants. However, accuracy was lower with MGD. Abbreviations: BNE = bilateral neck exploration; CT = computed tomography; IOPTH = intra-operative parathyroid hormone; MGD = multi-gland disease; MIBI = sestamibi; MIP = minimally invasive parathyroidectomy; MRI = magnetic resonance imaging; PHPT = primary hyperparathyroidism; PTA = parathyroid adenoma; PTH = parathyroid hormone; SGA = single-gland adenoma; SPECT = single photon emission computed tomography; 4D = four-dimensional.
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Makay Ö, Erol V, İçöz G, Öztürk Ş, Akdemir Ö, Akyıldız M. Kozmetik yönüyle minimal invaziv paratiroidektomi: Minimal invaziv yaklaşım daha mı üstün? EGE TIP DERGISI 2018. [DOI: 10.19161/etd.415654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Guo R, Wang J, Zhang M, Zhang M, Meng H, Zhang Y, Li B. Value of 99mTc-MIBI SPECT/CT parathyroid imaging and ultrasonography for concomitant thyroid carcinoma. Nucl Med Commun 2018; 38:676-682. [PMID: 28614134 DOI: 10.1097/mnm.0000000000000692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We aimed to assess the frequency of carcinoma in cases with suspected parathyroid adenoma and test the value of Tc-methoxyisobutylisonitrile (Tc-MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT) parathyroid imaging and neck ultrasonography in detecting concomitant thyroid carcinoma. PATIENTS AND METHODS We enrolled 741 patients with clinically suspected parathyroid adenoma who underwent Tc-MIBI planer scans and SPECT/CT of the skull base, neck, and thorax; patients also underwent ultrasonography within 1 month before SPECT/CT. Each case with suspected lesion was analyzed and correlated with pathology. We estimated the frequency of carcinoma detection on SPECT/CT performed for suspected parathyroid adenoma. The sensitivity, specificity, and accuracy of detecting thyroid carcinoma were estimated for both SPECT/CT and ultrasonography. RESULTS In total, 222 patients with 250 pathology results were assessed. Of these, 54 patients showed carcinoma. With respect to the anatomical distribution of the incidental findings, 19 (35.19%) had parathyroid carcinoma, 20 (37.04%) had papillary thyroid carcinoma, three (5.56%) had follicular thyroid carcinoma, six (11.11%) had medullary thyroid carcinoma, and six (11.11%) had other carcinomas. For thyroid carcinoma detection, the sensitivity, specificity, and accuracy were 35.71, 88.16, and 80.49% for SPECT/CT and 73.81, 95.10, and 91.99% for ultrasonography, respectively. CONCLUSION The frequency of carcinoma is high on Tc-MIBI SPECT/CT performed for suspected parathyroid adenoma. Although Tc-MIBI SPECT/CT plays an important role in the diagnosis and location of parathyroid adenoma, ultrasonography appears to be more suitable for identifying a concomitant thyroid carcinoma. This may vitally influence the choice of therapeutic regimen in patients with primary hyperparathyroidism.
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Affiliation(s)
- Rui Guo
- Departments of aNuclear Medicine bEndocrine and Metabolic Diseases, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Ozderya A, Temizkan S, Gul AE, Ozugur S, Cetin K, Aydin K. Biochemical and pathologic factors affecting technetium-99m-methoxyisobutylisonitrile imaging results in patients with primary hyperparathyroidism. Ann Nucl Med 2018; 32:250-255. [PMID: 29404934 DOI: 10.1007/s12149-018-1239-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/29/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Technetium 99 m methoxyisobutylisonitrile (Tc-99m MIBI) scintigraphy represents the most commonly utilized imaging modality for the detection of the diseased gland in patients with primary hyperparathyroidism (PHPT). In this study, we aimed to identify potential biological factors with an impact on MIBI sensitivity. METHODS A total of 147 patients with surgically confirmed parathyroid adenomas were assessed retrospectively. Data including medical history, biochemical and hormonal measurements, cervical US, Tc-99m MIBI scans as well as pathology reports were retrieved and recorded. RESULTS Of the 147 patients, there were a total of 77, 39, and 31 cases with a positive, negative, and suspicious parathyroid adenoma on Tc-99m MIBI scan, respectively. Serum calcium (Ca), parathyroid hormone (PTH) and 25 (OH) D levels were comparable among MIBI positive and negative patients [Ca: 11.5 ± 0.9 vs 11.3 ± 0.9 mg/dL (P = 0.42); PTH: 216 (146-347) vs 194 (140-317) pg/mL (P = 0.45); 25(OH)D: 8.4 (5.7-18.2) vs 10.0 (4.7-23.3) ng/mL (P = 0.64), respectively]. P-glycoprotein (P-gp) staining was negative in both groups. Also, pathological examination of tissue preparations revealed no difference in terms of the volume of the adenomas, incidence of cystic adenomas, cell-type dominance (oxyphilic cell), percent fat, and Ki-67 ratio in MIBI positive and negative groups. The rate of hyalinization was 13% in MIBI positive and 28% in MIBI negative subjects, the difference being statistically significant (P = 0.04). CONCLUSION Presence of hyalinization in parathyroid adenomas was found to be negatively correlated with MIBI scan results.
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Affiliation(s)
- Aysenur Ozderya
- Department of Endocrinology and Metabolic Disorders, Kartal Dr. Lutfi Kirdar Training and Research Hospital, 34890, Istanbul, Turkey
| | - Sule Temizkan
- Department of Endocrinology and Metabolic Disorders, Kartal Dr. Lutfi Kirdar Training and Research Hospital, 34890, Istanbul, Turkey.
| | - Aylin Ege Gul
- Department of Pathology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, 34890, Istanbul, Turkey
| | - Sule Ozugur
- Department of Nuclear Medicine, Kartal Dr. Lutfi Kirdar Training and Research Hospital, 34890, Istanbul, Turkey
| | - Kenan Cetin
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, 34890, Istanbul, Turkey
| | - Kadriye Aydin
- Department of Endocrinology and Metabolic Disorders, Kartal Dr. Lutfi Kirdar Training and Research Hospital, 34890, Istanbul, Turkey
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Lee F, Ha JF, Lannigan FJ. Minimal access thyroid surgery in children: A retrospective study and literature review. SURGICAL TECHNIQUES DEVELOPMENT 2017. [DOI: 10.4081/std.2017.6398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Minimal access thyroid surgery (MATS) is a technique whereby a part of or whole of a thyroid lobe is removed through a small (3-4 cm) neck incision. Its use in the surgical management of thyroid disease in children has not been well elucidated. We present a retrospective case study of 12 patients over the period of 2007 to 2010 to assess the feasibility of MATS in the management of thyroid disease. Minimal access thyroid surgery is a safe and feasible approach for hemithyroidectomy/lobectomy in selected patients. There were no associated adverse events, complications or disease recurrence. We also reviewed the literature and discussed the use of MATS as a routine procedure in selected pediatric patients.
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A retrospective study of elevated post-operative parathormone in primary hyperparathyroid patients. Oncotarget 2017; 8:101158-101164. [PMID: 29254153 PMCID: PMC5731863 DOI: 10.18632/oncotarget.20416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/16/2017] [Indexed: 11/25/2022] Open
Abstract
We retrospectively analyzed the relationship between normocalcemic parathormone elevation (NPE) and recurrence of primary hyperparathyroidism (pHPT) after surgery, as well as the risk factors of NPE. Out of 309 patients with pHPT that underwent parathyroidectomy. Six months after surgery, 75 patients exhibited NPE with high preoperative serum levels of alkaline phosphatase, calcium and intact parathyroid hormone (iPTH), postoperative day 1 iPTH, and large parathyroid volume. 15 exhibited NPE at 2 years after surgery with low serum vitamin D levels. Postoperative serum iPTH levels gradually normalized in most patients. Multivariate analysis showed that male patients were at greater risk for postoperative NPE (p<0.05). Only 3 of 309 patients showed recurrence during the follow-up period. NPE may not predict recurrent hyperparathyroidism or incomplete parathyroidectomy for benign parathyroid lesions. Postoperative NPE thus appears to be a response to severe hyperparathyroidism and vitamin D deficiency.
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