Effectiveness and Safety of Thermal Ablation in the Treatment of Primary Hyperparathyroidism: A Multicenter Study

Abstract

Purpose To evaluate the effectiveness and safety of thermal ablation for primary hyperparathyroidism (pHPT). Materials and Methods From January 2015 to March 2020, data pertaining to patients who received thermal ablation for pHPT at 4 centers were retrospectively analyzed. The median follow-up duration was 18.1months (IQR: 6.5-42.2 months). A cure referred to the reestablishment of normal values of serum calcium and intact parathyroid hormone (iPTH) throughout the entire follow-up period, at least more than 6 months. The technical success, effectiveness, and safety of treatment were analyzed. Results 119 patients (mean age, 57.2 ± 16.3 years; 81 female) with 134 parathyroid nodules were enrolled. The mean maximum diameter of the parathyroid glands was 1.6 ± 0.9 cm. Ninety-six patients underwent microwave ablation (MWA), and 23 patients underwent radiofrequency ablation (RFA). The technical success rate was 98.3% and the cure rate was 89.9%. Significant differences were found in the maximum diameter between the cured patients and the patients who did not undergo ablation of the target lesions. Except the cases with pHPT nodules<0.6cm in diameter, the cure rate was 95%. There were no difference in cure rates at 6 months between the MWA and RFA (MWA vs. RFA, 90.6% vs. 87.0%; χ2=0.275, p = 0.699). The volume reduction rate of the ablation zone was 94.6% at 12 months. The complication rate was 6.7% (8/119). Except one patient with persistent voice impairment, other symptoms were spontaneously resolved within six months. Conclusion Thermal ablation was effective and safe for pHPT.

Bone Turnover Markers in Response to Ultrasound-Guided Microwave Ablation for Primary Hyperparathyroidism

“…After 6-12 months of follow-up, two patients failed to show normal PTH or calcium levels. A multicenter study reported that the 7 out of 114 patients had recurrent PHPT during a follow-up period of 18.1 months ( 20 ). They found that a maximum diameter less than 0.6 cm resulted in missed ablation.…”

Efficacy and Safety of Ultrasound-Guided Radiofrequency Ablation for Primary Hyperparathyroidism: A Prospective Study

“…Complications include hoarseness, hypocalcemia, perioral and limb numbness, convulsions, subcutaneous edema, various degrees of pain, cough, skin burns, hematoma, infection, and life-threatening complications during or after RFA [ 18 34 35 ].…”

“…Since US-guided RFA was first used successfully in 2002 by Hänsler et al [ 17 ]. as a treatment for single parathyroid adenoma in humans, RFA has emerged as a novel method for managing PHPT [ 16 18 19 ]. However, to the best of our knowledge, no prospective studies have reported on patients who underwent RFA for PHPT.…”

An effective and safe alternative treatment method in parathyroid adenomas: Radiofrequency ablation

“…Although thermal ablation has provided promising outcomes in PHPT treatment, a majority of the studies have a small patient number and a short follow‐up term thus yielding limited definitive evidence on the effectiveness of this method. Yet, in a recent multicenter study, thermal ablation (MWA and RFA) has been demonstrated as an effective and reliable method in PHPT treatment 10 …”

“…Yet, in a recent multicenter study, thermal ablation (MWA and RFA) has been demonstrated as an effective and reliable method in PHPT treatment. 10 In the current issue of Journal of Clinical Ultrasound: Sonography and other Imaging Techniques, Ebrahiminik H et al have reported a retrospective study incorporating data from 27 patients with single parathyroid adenoma who were treated using ultrasound-guided RFA. 11 The study included patients diagnosed with parathyroid adenoma based on clinical, laboratory, and imaging findings who have refused undergoing surgery.…”