Complementary role of parathormone washout test to  99m Tc-MIBI parathyroid scintigraphy and histopathologic analysis of cell types in parathyroid adenomas

İnce, Semra; Emer, Özdeş; Deveci, Salih; Okuyucu, Kürşat; Alagöz, Engin; Şan, Hüseyin; Ayan, Aslı; Karaçalioğlu, Özgür; Haymana, Cem; Günalp, Bengül; Arslan, Nuri

doi:10.1016/j.remnie.2018.01.001

Cited by 4 publications

(3 citation statements)

References 23 publications

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“…The efficacy of PTHw in the proper localization of PA is higher in lesions presenting sonographic features typical of PA and a maximum lesion diameter below 10 mm. Although there is no particular threshold of size, the sensitivity of MIBI increases the PA size [9], which is consistent with our findings. PTHw has lower diagnostic potential in cases of multifocal PA or parathyroid hyperplasia (i.e., in case of MEN syndrome), as PA may mimic thyroid lesions or lymph nodes [10,11].…”

Section: Discussionsupporting

confidence: 92%

Clinical, Biochemical, and Sonographic Factors Influencing Performance of Parathormone Washout Measurement vs. 99mTc-MIBI Scintigraphy in the Preoperative Diagnostics of Parathyroid Adenomas

Szczepanek‐Parulska

Filipowicz

Czepczyński

et al. 2023

JCM

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The purpose of the study was to assess the clinical, biochemical, and sonographic factors influencing the performance of parathormone washout measurement (PTHw) vs. MIBI in the preoperative localization of parathyroid adenoma (PA). The studied group consisted of 39 patients with primary or tertiary hyperparathyroidism. The measurement of PTH concentrations was performed using an electro-chemiluminescence immunoassay. Scintigraphic localization of PA was carried out using dual-tracer planar neck scintigraphy, using 74 MBq 99mTc-pertechnetate and 740 MBq of 99mTc-MIBI. MIBI was unambiguously positive in 74% of patients. Among patients with negative or inconclusive MIBI, 90% had a positive PTHw result. Among patients with negative PTHw, two out of three had a positive MIBI result. The PTHw of lesions <10 mm in their largest diameter yielded positive results in 95%, compared to 75% for MIBI. For lesions ≥10 mm in largest diameter, 88% were visualised using MIBI. In conclusion, PTHw is a highly effective, easy, quick, safe, and relatively cheap procedure which might be considered for PA localisation, especially in patients with lesions presenting typical ultrasound features and a size below 10 mm. MIBI remains a useful procedure in specialized centres, particularly for patients in whom PTHw failed, larger lesions, and in cases of the ectopic location of PA.

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Section: Discussionsupporting

confidence: 92%

Clinical, Biochemical, and Sonographic Factors Influencing Performance of Parathormone Washout Measurement vs. 99mTc-MIBI Scintigraphy in the Preoperative Diagnostics of Parathyroid Adenomas

Szczepanek‐Parulska

Filipowicz

Czepczyński

et al. 2023

JCM

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“…However, in certain circumstances, the need to further identify the culprit gland, including measurement of high PTH in a lesion suspected as a parathyroid adenoma, becomes relevant. These circumstances include discordant imaging findings, 3–5 challenging anatomy (multinodular goiter or concomitant Hashimoto's thyroiditis), 6–8 intrathyroid adenoma, 9 and a history of neck surgery 5 …”

Section: Introductionmentioning

confidence: 99%

“…These circumstances include discordant imaging findings, [3][4][5] challenging anatomy (multinodular goiter or concomitant Hashimoto's thyroiditis), [6][7][8] intrathyroid adenoma, 9 and a history of neck surgery. 5 A number of studies showed excellent sensitivity (up to 95%) and positive predictive value (PPV, up to 100%) of PTH washout [10][11][12][13][14][15] ; and provided reassurance regarding the immediate safety of the procedure.…”

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confidence: 99%

Parathyroid fine‐needle aspiration with parathyroid hormone washout as a preoperative localisation of parathyroid adenoma—A retrospective study

Klein,

Alsleibi,

Cohen

et al. 2023

Clinical Endocrinology

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Objective: The use of parathyroid lesion aspiration in preoperative adenoma localisation is controversial. Concerns have been raised regarding both immediate safety (hematoma, infection, alterations on a subsequent histologic preparate) and long-term safety (seeding).We aimed to evaluate the short-and long-term safety, and the efficacy, of parathyroid fine-needle aspiration with parathyroid hormone washout as a localisation modality of parathyroid adenoma in patients with primary hyperparathyroidism.Design: A retrospective study. Patients:The sample comprised 29 patients with primary hyperparathyroidism who underwent minimally invasive parathyroidectomy at a tertiary referral centre, following localisation with parathyroid hormone washout. Measurements:We reviewed all parathyroid hormone washout procedures performed during 2011-2021. Clinical, biochemical, and imaging information; and cytology, surgery, and pathology reports were extracted from electronic medical records.Results: Parathyroid hormone levels from the needle wash were 2.1-112.5 times the upper limit of the serum norm. Other than mild neck discomfort, no immediate procedure complications were documented. Fibrotic changes and necrosis were reported in two patients, with no effect on the final pathologic diagnosis or surgery course. No long-term complications (seeding, or parathyromatosis) were found. A total of 26 (90%) patients who were operated following a positive parathyroid hormone washout result were normocalcemic at the end of a mean 38.1-month follow-up period.Conclusions: Parathyroid fine-needle aspiration with parathyroid hormone washout was accurate. Immediate, surgical, or delayed complications were not demonstrated in our series. This approach might be considered for selected patients.

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The Current Role of Parathyroid Fine-Needle Biopsy (P-FNAB) with iPTH-Washout Concentration (iPTH-WC) in Primary Hyperparathyroidism: A Single Center Experience and Literature Review

et al. 2022

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Introduction. Primary hyperparathyroidism (PHPT) is a condition characterized by disorders of calcium–phosphate metabolism and bone metabolism caused by pathological overproduction of parathyroid hormone (PTH). The diagnosis of overt PHPT is based on the presence of clinical symptoms and laboratory abnormalities typical of this condition: hypercalcemia, hypercalciuria and elevated iPTH levels. Imaging studies are not used for diagnostic purposes; they are performed to localize the parathyroid glands prior to potential surgical treatment. Technetium 99 m sestamibi scintigraphy (Tc99 m-MIBI) is the gold standard in the assessment of pathologically altered parathyroid glands. Other diagnostic options include cervical ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). Parathyroid biopsy (P-FNAB) with iPTH washout concentration (iPTH-WC) assessment is still an underestimated method of preoperative parathyroid gland localization. Few studies have reported the utility of US-guided P-FNAB in preoperative assessment of parathyroid lesions. The aim of the study was to present our experience with 143 P-FNAB with iPTH-WC assessment. Material and methods. Laboratory results, US findings, P-FNAB complications and comparison with other imaging techniques were described and analyzed. Results. In 133 (93.0) patients, iPTH washout-to-serum ratio exceeded threshold level 0.5 and were classified as positive results. Median iPTH-WC in this group was 16,856 pg/mL, and the iPTH-WC to serum iPTH ratio was 158. There was no correlation between iPTH-WC and serum PTH, serum calcium, parathyroid gland volume and shape index. In the group of 46 operated patients, 44 demonstrated positive iPTH-WC results, which corresponds to a sensitivity of 95.6%. In Tc99-MIBI, radiotracer retention was found in 17 cases (in 24 MIBI performed), which corresponds to a sensitivity of 52.2%. P-FNAB did not cause any major side effects −92.5% of all patients had no or mild adverse events after this procedure. Conclusions. P-FNAB with iPTH-WC is a reliable method in parathyroid adenoma localization during PHPT. Its sensitivity for diagnosis of PHPT is much higher than that of Tc99-MIBI, and in some situations, P-FNAB with iPTH-WC may even replace that method. Furthermore, cost-effectiveness of iPTH-WC is at least similar to that of Tc99-MIBI. Complications of P-FNAB are mild and we can describe this method as a safe procedure.

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Complementary role of parathormone washout test to 99m Tc-MIBI parathyroid scintigraphy and histopathologic analysis of cell types in parathyroid adenomas

Cited by 4 publications

References 23 publications

Clinical, Biochemical, and Sonographic Factors Influencing Performance of Parathormone Washout Measurement vs. 99mTc-MIBI Scintigraphy in the Preoperative Diagnostics of Parathyroid Adenomas

Clinical, Biochemical, and Sonographic Factors Influencing Performance of Parathormone Washout Measurement vs. 99mTc-MIBI Scintigraphy in the Preoperative Diagnostics of Parathyroid Adenomas

Parathyroid fine‐needle aspiration with parathyroid hormone washout as a preoperative localisation of parathyroid adenoma—A retrospective study

The Current Role of Parathyroid Fine-Needle Biopsy (P-FNAB) with iPTH-Washout Concentration (iPTH-WC) in Primary Hyperparathyroidism: A Single Center Experience and Literature Review

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