Diagnosis and Surgical Treatment of Mediastinal Parathyroid Tumors

Rothmund, M.; Diethelm, L; Brünner, H; Kümmerle, F

doi:10.1097/00000658-197602000-00010

Cited by 35 publications

(21 citation statements)

References 28 publications

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“…30 Kusakabe et al 34 compared the results of 99m Tcsestamibi scintigraphy and US evaluation in patients with hyperparathyroidism and discovered that the effi cacy of these imaging procedures was 100% and 97%, respectively. 99m Tc-sestamibi scintigraphy showed to be highly effective in discovering ectopic hyperfunctioning parathyroid glands, which according to Rothmund et al 35 can be observed in 20% of the cases with PHPT and can represent a diagnostic and therapeutic problem. Rubello et al 36 examined 18 patients with PHPT and determined the sensitivity of 99m Tc-sestamibi scintigraphy and US for discovering abnormal glands to be 100% and 83.3%, respectively.…”

Section: Parathyroid Scintigraphy With 99m Tc -Sestamibimentioning

confidence: 99%

Nuclear Medicine Methods for Evaluation of Abnormal Parathyroid Glands in Patients with Primary and Secondary Hyperparathyroidism

Botushanova¹,

Botushanov²,

M³

2017

Folia Medica

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Considered rare disease in the past, primary hyperparathyroidism (PHPT) has dramatically increased in incidence over the past thirty years with the introduction of routine calcium measurements; it is now approximately 42 per 100 000 persons. By far, the most common lesion found in patients with PHPT is the solitary parathyroid adenoma, occurring in 85%-90% of patients, while in the rest 10%- 15% primary hyperplasia of the parathyroid glands is present. Currently, the most widely used surgical approach is minimally invasive parathyroidectomy which is associated with less post-surgery complications and shorter operation time. To be successful this procedure needs to rely on a precise preoperative localization of the abnormal parathyroid glands, hence preoperative parathyroid imaging gained so large importance. The rationale for locating abnormal parathyroid tissue prior to surgery is that the glands can be notoriously unpredictable in their location. There is a general consensus that the best imaging procedure identifying abnormal parathyroid glands is the preoperative scintigraphy with 99mTc-sestamibi or 99mTc-tetrofosmin. It is characterized with high sensitivity and specificity exceeding those of ultrasound, CT or MRI. Combining scintigraphy with the other imaging techniques increases the precision for topic localization.

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Section: Parathyroid Scintigraphy With 99m Tc -Sestamibimentioning

confidence: 99%

Nuclear Medicine Methods for Evaluation of Abnormal Parathyroid Glands in Patients with Primary and Secondary Hyperparathyroidism

Botushanova¹,

Botushanov²,

M³

2017

Folia Medica

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“…This can be responsible for conventional surgical failures in up to one third of patients. [2][3][4] In 2% of these patients, intrathymic ectopic parathyroid tissue was found 3 to 4 cm below the sternal notch. 7 In this situation, preoperative imaging studies are required to localize parathyroid tissue and to guide the surgery, which is known to be more complicated than first-time surgery.…”

Section: Discussionmentioning

confidence: 97%

Unexpected Detection of an Intrathymic Parathyroid Adenoma by Tc-99m-MIBI Scintigraphy

lu¹,

Bozkurt²,

an³

et al. 2005

The Endocrinologist

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Although most parathyroid adenomas are located in the neck, approximately 25% of them are found deep in the mediastinum. These ectopic adenomas are one of the major causes for failure of bilateral neck exploration because it is almost impossible to reach deep mediastinal tissues from a standard neck incision unless sternotomy is performed. So, although preoperative localization methods are not routinely recommended for the surgical planning of primary hyperparathyroidism, whenever ectopic parathyroid tissues is suspected, preoperative localization can guide the surgery and prevent surgical failure. In this report, we present a case with the diagnosis of primary hyperparathyroidism in whom preoperative Tc-99m-MIBI double-phase scintigraphy, performed for an ongoing research project, revealed an unexpected hyperfunctioning parathyroid nodule in the mediastinum. Subsequent computed tomography and magnetic resonance imaging confirmed an ectopic mediastinal parathyroid adenoma. The surgical approach was modified so that a median sternotomy as well as bilateral neck exploration was performed. A large intrathymic parathyroid adenoma was identified and excised through the sternotomy. In this case, Tc-99m-MIBI scintigraphy successfully localized an unexpected hyperfunctioning mediastinal parathyroid adenoma and played a key role in the surgical planning for the patient. Although not recommended for routine preoperative evaluation, scintigraphy can be useful in the preoperative localization of ectopic parathyroid adenomas, and it may make it possible for the surgeon to modify the surgical approach in selected cases. (The Endocrinologist 2005;15: 366 -369) Learning Objectives• Explain the rationale for performing Tc-99m-MIBI scintigraphy when planning surgical treatment of primary hyperparathyroidism as exemplified by this patient, who was scanned as part of an ongoing research project. • Recall which phases of the scintigraphic study displayed increased isotope uptake, and point our whether and how the findings altered surgical planning in this instance. • Compare scintigraphy with various imaging methods for routine preoperative use in patients who are to have an initial parathyroidectomy.P rimary hyperparathyroidism is cured in more than 90% of patients using standard bilateral neck exploration without any need for preoperative localization methods. 1 Parathyroid adenomas are the causative factor for hyperparathyroidism in approximately 85% of cases, and although most of the adenomas are known to be located in the neck, it is been reported in some series that approximately 25% of them can be found deep in the mediastinum. 2,3 These ectopic adenomas are one of the major causes of failure for bilateral neck exploration. 4 Although preoperative localization methods are not routinely recommended for the surgical planning of primary hyperparathyroidism, 1 in some cases, when an ectopic parathyroid pathology is suspected, preoperative localization can be very helpful to the surgery and help avoid surgical failure.

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“…The lowest level of accumulation corresponds to G(0) phase and the highest to phase G(2) + S. No such correlation with the weight of the glands is found [49]. The fixation of the radionuclide depends on the functional status of the tissues, i.e., increased accumulation accompanies the cells' active growing phase or is directly connected to the state of autonomy of the parathyroid cells [46].…”

Section: Single-isotope Dual-phase Scintigraphy With 99m Tc-sestamibimentioning

confidence: 98%

“…Hyperplastic parathyroid glands are visualized in 10-62.5% of the cases [44,45]. In multiple endocrine neoplasia syndrome (MEN), where hyperplasia of the parathyroid glands is common, only 55% of the abnormal glands are seen on 99m Tc-sestamibi scintigraphy [42,46,47]. 99m Tcsestamibi scintigraphy shows to be highly effective in discovering ectopic hyperfunctioning parathyroid glands, which in some studies, are observed in approximately 20% of the cases with PHPT and represent a diagnostic and therapeutic challenge [48].…”

Section: Single-isotope Dual-phase Scintigraphy With 99m Tc-sestamibimentioning

confidence: 99%

Parathyroid Scintigraphy

Botushanova¹,

Botushanov²

2021

Medical Isotopes

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The visualization of abnormal parathyroid glands is difficult due to their variations in number and localization. Noninvasive parathyroid imaging studies include 99m Tcsestamibi scintigraphy, ultrasonography, computed tomography scanning, magnetic resonance imaging, and positron emission tomography. There is a general consensus that the most sensitive and specific imaging modality, especially when it is combined with single-photon emission CT is the scintigraphy with 99m Tc-sestamibi or 99m Tctetrofosmin. 99m Tc-sestamibi scintigraphy significantly increases the role of preoperative scintigraphy in patients with hyperparathyroidism and allows unilateral surgical approach with minimally invasive parathyroidectomy to be used. Generally, three protocols with the use of two radiopharmaceuticals, 99m Tc-sestamibi or 99m Tc-tetrofosmin, are most widely applied: single-phase dual-isotope subtraction, dual-phase single-isotope and combination of both. Each one of them has specific advantages and disadvantages. While single parathyroid adenomas are localized with greater precision, hyperfunctioning parathyroid hyperplastic cells represent a real challenge to the imaging modalities. Several factors can influence the radionuclide uptake in pathologically changed parathyroid cells, like the size, the level of their functional activity, the quantity of oxyphilic cells, mitochondria, P glycoprotein and other MDR gene products.

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Diagnosis and Surgical Treatment of Mediastinal Parathyroid Tumors

Cited by 35 publications

References 28 publications

Nuclear Medicine Methods for Evaluation of Abnormal Parathyroid Glands in Patients with Primary and Secondary Hyperparathyroidism

Nuclear Medicine Methods for Evaluation of Abnormal Parathyroid Glands in Patients with Primary and Secondary Hyperparathyroidism

Unexpected Detection of an Intrathymic Parathyroid Adenoma by Tc-99m-MIBI Scintigraphy

Parathyroid Scintigraphy

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