Computed tomography can guide focused exploration in select patients with primary hyperparathyroidism and negative sestamibi scanning

Harari, Avital; Zarnegar, Rasa; Lee, James; Kazam, Elias; Inabnet, William B.; Fahey, Thomas J.

doi:10.1016/j.surg.2008.08.029

Cited by 66 publications

(40 citation statements)

References 18 publications

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“…Computed tomography (CT) provides high-quality two (sometimes three)-dimensional anatomical images and has a reported sensitivity of 66% and specificity of 89% [12]. It is possible to use positron emission tomography in combination with CT to detect the hyperfunctioning gland, but this is not yet widely implemented [13].…”

Section: Introductionmentioning

confidence: 99%

Surgeon-Performed Ultrasound as Preoperative Localization Study in Patients with Primary Hyperparathyroidism

et al. 2011

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Background: Minimally invasive parathyroidectomy is the treatment of choice for single-gland primary hyperparathyroidism. However, the exact location of the abnormal gland has to be established. Sestamibi scintigraphy, computed tomography and ultrasound (US) are commonly used modalities. We describe our experience in a non-academic center with surgeon-performed US (S-US) of the neck as preoperative localization study in patients with primary hyperparathyroidism (PHPT). Methods: Patients with a biochemically proven diagnosis of PHPT and preoperative S-US were included. Data were recorded prospectively. Perioperative gland location was compared to the preoperative S-US to determine sensitivity, specificity and accuracy rates. Results: Two of the 50 patients who underwent S-US were not subjected to surgery. In 85% of the patients analyzed by S-US, the appropriate abnormal gland(s) were identified. In 11%, no gland was identified, but abnormal glands were found during surgery. Sensitivity of S-US in our hospital is 85%, with a positive predictive value of 97%. Conclusions: We achieved a satisfactory sensitivity rate. S-US provides anatomic information to the surgeon which enables a more detailed operation planning, and it is a valuable diagnostic modality for patients with PHPT in our opinion. We hope that our data encourage other centers to implement this technique as well.

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Section: Introductionmentioning

confidence: 99%

Surgeon-Performed Ultrasound as Preoperative Localization Study in Patients with Primary Hyperparathyroidism

et al. 2011

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“…7,8 In one study, CT was found to be 85% sensitive and 94% specific for correctly lateralizing the side of the diseased gland and 66% sensitive and 89% specific for predicting the exact location of the diseased gland. 9 Sestamibi scintigraphy has a reported sensitivity range of 70% to 90% and specificity ranging between 81% and 91%. [10][11][12][13][14][15] Recently, the impact of ionizing radiation exposure from medical studies on the risk of cancer has become a public health concern.…”

Section: Conclusion and Relevancementioning

confidence: 99%

Comparison of Radiation Exposure and Cost Between Dynamic Computed Tomography and Sestamibi Scintigraphy for Preoperative Localization of Parathyroid Lesions

Madorin¹,

Owen²,

Coakley³

et al. 2013

JAMA Surg

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Importance: Dynamic computed tomography (CT) is emerging as a first-line alternative to sestamibi scintigraphy for preoperative localization of parathyroid lesions. In recent years, there has been increased concern over the impact of radiation exposure from medical imaging, as well as on the cost of diagnostic medical procedures. An ideal diagnostic procedure would be cost effective while minimizing hazardous exposures and complication rates.Objective: To compare the radiation dose and financial cost of dynamic CT with sestamibi scintigraphy. Main Outcomes and Measures:The 2 primary study outcomes were radiation exposure measured in millisieverts (mSv) and medical charges for the respective diagnostic procedures. The study was conducted with the hypothesis that dynamic parathyroid CT would have slightly greater radiation exposure with similar cost to sestamibi scintigraphy.Results: Dynamic parathyroid CT and sestamibi scintigraphy delivered mean radiation doses of 5.56 and 3.33 mSv, respectively (P Ͻ .05). Charges totaled $1296 for thin-cut dynamic parathyroid CT and a mean of $1112 for sestamibi scintigraphy, depending on the type and amount of radiotracer injected. Although multiphase CT scanning took less than 5 minutes, sestamibi scintigraphy lasted a mean time of 306 minutes. A total of 62 of 119 patients (52%) in the CT group have undergone operative treatment to date, whereas all patients in the sestamibi arm underwent operative treatment of their hyperparathyroidism. Of the patients who underwent a surgical procedure, CT correctly identified the side of the parathyroid adenoma in 54 of 62 patients (87%), while sestamibi scintigraphy only correctly lateralized 90 of 122 adenomas (74%) as confirmed by exploratory surgery, intraoperative parathyroid hormone levels, and pathologic features. A dynamic parathyroid CT correctly predicted multiglandular disease in 1 of 7 patients (14%), while sestamibi scintigraphy correctly predicted multiglandular disease in 8 of 23 patients (35%). Conclusions and Relevance:In patients who underwent directed parathyroid surgery, dynamic CT is comparable to sestamibi scintigraphy in patients with hyperparathyroidism. Although CT delivers a higher dose of radiation, the average background radiation exposure in the United States is 3 mSv/y, and added exposures of less than 15 mSv are considered low risk for carcinogenesis. Overall, dynamic parathyroid CT is a safe, cost-effective alternative to sestamibi scintigraphy.

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“…16,17 Initial results were disappointing for parathyroid adenoma localization; however, improved sensitivity has been reported with thincut contrast-enhanced studies. 18 Recently, several studies have examined the use of 4-dimensional (4D) CT scanning. [19][20][21][22] This modality combines 3-dimensional (3D) reconstruction of CT images with the added dimension of contrast diffusion over time.…”

Section: See Invited Critique At End Of Articlementioning

confidence: 99%

Virtual Neck Exploration for Parathyroid Adenomas

D’Agostino¹,

Wall²,

Soler³

et al. 2013

JAMA Surg

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Objective: To evaluate the performance of 3-dimensional (3D) virtual neck exploration (VNE) as a modality for preoperative localization of parathyroid adenomas in primary hyperparathyroidism and assess the feasibility of using augmented reality to guide parathyroidectomy as a step toward minimally invasive imageguided surgery.Design: Enhanced 3D rendering methods can be used to transform computed tomographic scan images into a model for 3D VNE. In addition to a standard imaging modality, 3D VNE was performed in all patients and used to preoperatively plan minimally invasive parathyroidectomy. All preoperative localization studies were analyzed for their sensitivity, specificity, positive predictive value, and negative predictive value for the correct side of the adenoma(s) (lateralization) and the correct quadrant of the neck (localization). The 3D VNE model was used to generate intraoperative augmented reality in 3 cases. Setting: Tertiary care center.Patients: A total of 114 consecutive patients with primary hyperparathyroidism were included from January 8, 2008, through July 26, 2011.Results: The accuracy of 3D VNE in lateralization and localization was 77.2% and 64.9%, respectively. Virtual neck exploration had superior sensitivity to ultrasonography (PϽ.001), sestamibi scanning (P=.07), and standard computed tomography (PϽ.001). Use of the 3D model for intraoperative augmented reality was feasible.Conclusions: 3-Dimensional VNE is an excellent tool in preoperative localization of parathyroid adenomas with sensitivity, specificity, and diagnostic accuracy commensurate with accepted first-line imaging modalities. The added value of 3D VNE includes enhanced preoperative planning and intraoperative augmented reality to enable less-invasive image-guided surgery.

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Computed tomography can guide focused exploration in select patients with primary hyperparathyroidism and negative sestamibi scanning

Cited by 66 publications

References 18 publications

Surgeon-Performed Ultrasound as Preoperative Localization Study in Patients with Primary Hyperparathyroidism

Surgeon-Performed Ultrasound as Preoperative Localization Study in Patients with Primary Hyperparathyroidism

Comparison of Radiation Exposure and Cost Between Dynamic Computed Tomography and Sestamibi Scintigraphy for Preoperative Localization of Parathyroid Lesions

Virtual Neck Exploration for Parathyroid Adenomas

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