Cervical ultrasound combined with parathyroid hormone assay prior to parathyroid exploration

Mäkäräinen, H; Raija, Takalo; MattiV, Kairaluoma; Pasi, Salmela

doi:10.1007/bf00595829

Cited by 4 publications

(3 citation statements)

References 20 publications

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“…of the suspicious parathyroid lesion to establish the parathyroid nature of the cervical mass has been proposed (9)(10)(11)(17)(18)(19). Previous studies have clearly shown the feasibility and accuracy of this procedure.…”

Section: Serum Pth Ptha Site Of the Sizementioning

confidence: 99%

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Preoperative localization of suspicious parathyroid adenomas by assay of parathyroid hormone in needle aspirates

Marcocci

Mazzeo

Bruno-Bossio³

et al. 1998

European Journal of Endocrinology

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Objective: To determine the usefulness of parathyroid hormone (PTH) measurement in needle aspirates of a suspicious neck mass to confirm its parathyroid nature in patients with primary hyperparathyroidism. Methods: Thirty-three patients with surgically proved primary hyperparathyroidism were submitted to neck ultrasound (US), parathyroid scintigraphy, and assay of PTH in the aspirate (PTHa) of the suspicious cervical mass. Results: Based on the results of neck US and parathyroid scintigraphy, patients were divided into two groups. Group 1: 16 patients (seven with nodular goiter) with concordant positive US and scintigraphic results. In all but one patient, PTHa was detectable and often markedly elevated (>1000 pg in 12 patients, between 292 pg and 803 pg in three patients and 53 pg in one patient). The patient with undetectable PTHa had a small lower left parathyroid adenoma (8×8×10 mm). Group 2: 17 patients (12 with nodular goiter) with discordant US and scintigraphic results. PTHa established the parathyroid nature of the mass in 13 cases (>1000 pg in 8 patients, between 501 pg and 953 pg in three patients and 90 and 79 pg in two patients): 11 of these had a suspected lesion by US examination but the scintigraphy results were negative; two had a mass that gave positive scintigraphy results but was of uncertain origin according to US; in both cases an intrathyroidal parathyroid adenoma was found. PTHa was undetectable in four cases (three with nodular goiter): all of these had equivocal US results, and three had positive scans and one a negative scan. Conclusions: Assay of PTHa is a simple method and should be useful for confirming the parathyroid nature of a cervical mass in patients with discordant or non-diagnostic US and scintigraphic results.

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Section: Serum Pth Ptha Site Of the Sizementioning

confidence: 99%

“…Previous studies have clearly shown the feasibility and accuracy of this procedure. Its use has been recommended for the evaluation of patients undergoing surgery after a previous negative neck exploration (10,18).…”

Section: Serum Pth Ptha Site Of the Sizementioning

confidence: 99%

Preoperative localization of suspicious parathyroid adenomas by assay of parathyroid hormone in needle aspirates

Marcocci

Mazzeo

Bruno-Bossio³

et al. 1998

European Journal of Endocrinology

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“…A realização de punção por agulha fina de nódu -los cervicais para diferenciação entre nódulo tiroideano ou paratiroideano fornece material escasso para análise citológica, e freqüentemente as características citomorfológicas são semelhantes tornando-se difícil determinar a natureza do nódulo puncionado (10). Desta forma, alguns estudos verificaram a utilidade da medida de PTH no aspirado de nódulos supostamente paratiroideanos para confirmar a natureza desta massa cervical suspeita e confirmaram que tal método é simples, seguro e muito informativo (11)(12)(13).…”

Section: Resultsunclassified

Hiperparatiroidismo primário: localização pré-operatória através da dosagem de paratormônio (PTH) em aspirado de punção de nódulo cervical

Hauache¹,

Santos²,

Vieira³

2002

Arq Bras Endocrinol Metab

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RESUMOO diagnóstico laboratorial de hiperparatiroidismo primário baseia-se no encontro de hipercalcemia na presença de níveis séricos elevados ou inapropriadamente normais de paratormônio (PTH). Uma vez confirmado o diagnóstico laboratorial, paratiroidectomia pode ou não ser indicada, na dependência de critérios clínicos e laboratoriais. Quando a cirurgia é indicada, diversos exames localizatórios de imagem cervicais (ultra-sonografia, tomografia, ressonância magnética, cintilografia) podem ser solicitados com o objetivo de auxiliar o cirurgião, indicando qual a localização de uma ou mais glândulas paratiróides aumentadas. Entretanto, tais exames apresentam sensibilidades variadas, na dependência quase sempre direta dos níveis séricos de PTH. Além disso, a coexistência de nódulos tiroideanos pode levar a resultados falso-positivos. Neste artigo, descrevemos três pacientes portadoras de hiperparatiroidismo primário com localização do nódulo cervical suspeito no pré-operatório. A natureza paratiroideana destes nódulos foi confirmada através da dosagem de PTH no material aspirado da punção dos respectivos nódu -los cervicais. High or inappropriately normal parathormone (PTH) levels in the presence of hypercalcemia are very suggestive of primary hyperparathyroidism. Once the biochemical diagnosis is confirmed, surgery may be indicated according to specific guidelines. When this is the case, several preoperative localization studies may be performed, such as ultrasonography, computerized tomography, magnetic resonance and parathyroid scintigraphy. These exams may be ordered in an attempt to help the surgeon by pointing out the precise localization of one or more enlarged parathyroid glands. However, these exams have variable sensitivities, which usually correlate with serum levels of PTH. Moreover, the coexistence of thyroid nodules may lead to false-positive observations. We herein describe three patients with primary hyperparathyroidism, whose parathyroid nature of preoperative suspicious localized cervical nodules were confirmed by PTH measurement in needle aspirates of these nodules. (Arq Bras Endocrinol Metab 2002;46/6:704-707 )

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Usefulness of echo-color Doppler in differentiating parathyroid lesions from other cervical masses

et al. 1997

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The aim of our study was to clarify possible differential color Doppler US features between parathyroid lesions and other cervical masses. A total of 56 parathyroid lesions in 54 patients with primary hyperparathyroidism were preoperatively examined with color Doppler sonography. Color Doppler flow patterns were compared with those of 72 thyroid nodules and 20 cervical lymph nodes. In 38 parathyroid lesions a correlation between color Doppler patterns and size, location, and pathological findings was performed. Color Doppler sonography showed five vascular distribution patterns: pattern I, absence of flow; pattern II, focal peripheral flow ("vascular pole") with arterial Doppler spectrum; pattern III, peripheral flow; pattern IV, internal flow ("parenchymal pattern"); pattern V, peripheral and intranodular flow. Pattern I was not specific for any cervical lesion considered. Conversely, pattern IV was observed solely in parathyroid lesions, and pattern II was observed in only one nonparathyroid lesion (thyroid nodule). Mixed pattern (pattern V) was observed solely in thyroid nodules. In addition, pattern III was a characteristic finding of thyroid nodules and was observed in only one parathyroid lesion. Color Doppler patterns of the parathyroid masses did not correlate with the size of the lesion or pathological findings, but only with the location of the gland. Our study showed that color Doppler assessment of parathyroid lesions is a useful integration of gray-scale US and may be helpful in distinguishing parathyroid lesions from other cervical masses.

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Cervical ultrasound combined with parathyroid hormone assay prior to parathyroid exploration

Cited by 4 publications

References 20 publications

Preoperative localization of suspicious parathyroid adenomas by assay of parathyroid hormone in needle aspirates

Preoperative localization of suspicious parathyroid adenomas by assay of parathyroid hormone in needle aspirates

Hiperparatiroidismo primário: localização pré-operatória através da dosagem de paratormônio (PTH) em aspirado de punção de nódulo cervical

Usefulness of echo-color Doppler in differentiating parathyroid lesions from other cervical masses

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