Does Intraoperative Quick Parathyroid Hormone Assay Improve the Results of Parathyroidectomy?

Miura, Daishu; Wada, Nobuyuki; Arıcı, Cumhur; Morita, Eugene; Duh, Quan‐Yang; Clark, Orlo H.

doi:10.1007/s00268-002-6620-1

Cited by 138 publications

(93 citation statements)

References 14 publications

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“…Fortunately, we could successfully remove hyperactive gland by excising single gland in the present series in most of the patients. It was reported that when surgeon-performed US showed positive or typical localization of at least one gland, MIP with IOPM could improve the result [19,20]. Although we could not determine the significance of IOPM in the present series, we might be able to prevent 2 bilateral explorations by employing IOPM.…”

Section: Discussionmentioning

confidence: 39%

Strategy of operative treatment of hyperparathyroidism using US scan and <sup>99m</sup>Tc-MIBI SPECT/CT

et al. 2014

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Primary hyPerParathyroidism (pHPT) is a disease for which the diagnosis and treatment have become relatively straightforward. The criteria for diagnosis have become standardized with either elevated blood calcium levels, the presence of kidney stones, or decreased bone densitometry. The primary causes of pHPT are classically said to be 80%-85% due to adenoma, 10% -15% due to hyperplasia, and ~1% due to carcinoma, respectively. Majority of responsible lesion of pHPT is, thus, a single adenoma. The standard of care of pHPT is a surgical excision of the responsible lesion(s). Therefore, accurate localiza- abstract. We evaluated the efficacy of technetium-sestamibi ( 99m Tc-MIBI) SPECT/CT for planning parathyroidectomy in cases with primary hyperparathyroidism (pHPT), comparing with planar scintigraphy and ultrasound (US), in an aim to establish the proper surgical strategy according to the preoperative imaging studies. A retrospective review of consecutive 75 pHPT patients who had been operated on was conducted. The results of preoperative imaging modalities and the operative finding were analyzed. Seven cases were found to have multiple hyperplastic glands, and no responsible gland was found in three cases. Four cases underwent only US scan for preoperative imaging. Remaining 61 cases were found to have single adenoma, and were included in the evaluation of localization imaging. US scan, 99m Tc-MIBI planar scan and 99m Tc-MIBI SPECT/CT showed accurate localization in 77.0% (47/61), 75.4% (46/61) and 88.5% (46/52) of the evaluable cases, respectively. US and 99m Tc-MIBI planar scan demonstrated consistent result in 42 cases (68.9%), and those cases showed accurate localization in 90.5% (38/42). When both US and 99m Tc-MIBI SPECT/CT was consistent, all 37 lesions had been correctly indicated. No clinico-pathological features were suggested to influence in demonstrating the localization, other than only 99m Tc-MIBI SPECT/CT exhibited 100% sensitivity in ectopic glands. Combination of US and 99m Tc-MIBI SPECT/CT certainly contributes to the planning of minimally invasive operation in cases with pHPT by indicating correct localization of single adenoma.Key words: Primary hyperparathyroidism, Technetium-sestamibi ( 99m Tc-MIBI), SPECT/CT tion analysis is important.The imaging techniques that have been used to identify the location of responsible lesion(s) are technetium-thallium subtraction scan, technetium-sestamibi ( 99m Tc-MIBI) scan, ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT) [1], venous sampling of parathyroid hormone, and angiography. To date, the best results have been found using either US or technetium imaging.The sensitivity of US for detecting a single parathyroid adenoma was 57 to 87 % [2][3][4][5][6][7]. However, parathyroid US is dependent on the experience of the operator [8] and has a suboptimal detection rate for multinodular thyroid disease and silent areas, such as the mediastinum, tracheoesophageal groove, and retroesophageal region [9]. Therefore, the practical choic...

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Section: Discussionmentioning

confidence: 39%

Strategy of operative treatment of hyperparathyroidism using US scan and <sup>99m</sup>Tc-MIBI SPECT/CT

et al. 2014

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“…28 Sestamibi scanning has a high positive predictive value, but is more accurate for single gland rather than multigland disease. [29][30][31][32] High resolution ultrasound scanning alone is less accurate than sestamibi scanning, but used in combination the accuracy of detection improves, [33][34][35] especially for single gland disease. 29 There is a false negative rate of up to 22% with sestamibi scans in primary hyperparathyroidism; this is more likely with small adenomas, multigland disease, superior glands, or normal preoperative calcium concentrations.…”

Section: Will the Parathyroid Frozen Section Soon Be Left Out In The mentioning

confidence: 99%

BEST PRACTICE NO 183: Examination of parathyroid gland specimens

Johnson

Sheffield²,

McNicol³

2005

Journal of Clinical Pathology

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“…IOPTH measurement has a reported sensitivity of 58% in detecting further adenomas in cases of multiple gland disease. 14 This relatively low figure suggests that while IOPTH is helpful in confirming single gland disease, it does not offer complete protection against missing additional abnormal glands. IOPTH measurement may produce both false positive and false negative results.…”

Section: Discussionmentioning

confidence: 97%

Contemporary surgical treatment of primary hyperparathyroidism without intraoperative parathyroid hormone measurement

Pafitanis

et al. 2015

annals

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INTRODUCTION Primary hyperparathyroidism (pHPT) is usually the result of a single adenoma that can often be accurately located preoperatively and excised by a focused operation. Intraoperative parathyroid hormone (IOPTH) measurement is used occasionally to detect additional abnormal glands. However, it remains controversial as to whether IOPTH monitoring is necessary. This study presents the results of a large series of focused parathyroidectomy without IOPTH measurement. METHODS Data from 2003 to 2014 were collected on 180 consecutive patients who underwent surgical treatment for pHPT by a single surgeon. Preoperative ultrasonography and sestamibi imaging was performed routinely, with computed tomography (CT) and/or selective venous sampling in selected cases. The preferred procedure for single gland disease was a focused lateral approach guided by on-table surgeon performed ultrasonography. Frozen section was used selectively and surgical cure was defined as normocalcaemia at the six-month follow-up appointment. RESULTS Focused surgery was undertaken in 146 patients (81%) and 97% of these cases had concordant results with two imaging modalities. In all cases, an abnormal gland was discovered at the predetermined site. Of the 146 patients, 132 underwent a focused lateral approach (11 of which were converted to a collar incision), 10 required a collar incision and 4 underwent a mini-sternotomy. At 6 months following surgery, 142 patients were normocalcaemic (97% primary cure rate). Three of the four treatment failures had subsequent surgery and are now biochemically cured. There were no complications or cases of persistent hypocalcaemia. CONCLUSIONS This study provides further evidence that in the presence of concordant preoperative imaging, IOPTH measurement can be safely omitted when performing focused parathyroidectomy for most cases of pHPT.

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Does Intraoperative Quick Parathyroid Hormone Assay Improve the Results of Parathyroidectomy?

Cited by 138 publications

References 14 publications

Strategy of operative treatment of hyperparathyroidism using US scan and <sup>99m</sup>Tc-MIBI SPECT/CT

Strategy of operative treatment of hyperparathyroidism using US scan and <sup>99m</sup>Tc-MIBI SPECT/CT

BEST PRACTICE NO 183: Examination of parathyroid gland specimens

Contemporary surgical treatment of primary hyperparathyroidism without intraoperative parathyroid hormone measurement

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