European multicentre study on outcome of surgery for sporadic primary hyperparathyroidism

Bergenfelz, Anders; Slycke, Sam Van; Makay, Özer; Brunaud, Laurent

doi:10.1002/bjs.12025

Cited by 29 publications

(40 citation statements)

References 24 publications

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“…Almquist M et al 2010 have shown a decrease in median PTA weight from 725 to 560 mg between 1990 and 2007 [8] and McCoy et al 2014, a decrease in average PTA weight from 1214 mg till 909 mg during the period 1997 to 2011 [9]. Furthermore, a recent population-based study, with 4890 histologically confirmed PTA, from a European surgical registry for endocrine tumours [10] showed a median PTA weight of 940 mg (interquartile range (IQR) 1570 mg). Compared to these results, our cohort was dominated by patients with small weight adenomas [median 315 mg (IQR 405)].…”

Section: Discussionmentioning

confidence: 97%

The preoperative localisation of small parathyroid adenomas improves when adding Tc-99m-Sestamibi SPECT to multiphase contrast-enhanced CT

et al. 2021

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Objectives To investigate the incremental value of Sestamibi SPECT combined with a non-enhanced and contrast-enhanced CT, using SPECT/CT, for the preoperative localisation of small parathyroid adenomas (PTA). Methods Retrospectively, 147 patients surgically cured from primary hyperparathyroidism, as verified by biochemistry 6 months postoperatively, were included. All patients had preoperatively undergone a dual time 99mTechnetium-Sestamibi SPECT (S) with multiphase CT including native (N), arterial (A) and venous (V) phases. Independently, two radiologists blinded from both the surgical and the preoperative imaging reports, sequentially performed PTA localisation starting with either [A] or [V], thereafter [A + N] or [V + N] and finally with the complete [A + N + S] or [V + N + S]. PTA localisation was reported for each image-set. The readers results were combined and the diagnostic performance for each image set was determined. Sensitivity was also calculated for the different quartiles of PTA weight distribution. Results The median adenoma weight was 315 mg. No statistically significant differences in diagnostic performance between arterial and venous based image sets were found. The net effect of adding [N] was to increase specificity. Sestamibi SPECT significantly increased the overall diagnostic accuracy for arterial- and venous-based image sets, p = 0.0008 and p = 0.001, respectively. [A + N + S] was found to have the highest diagnostic performance with 86.5% sensitivity and 94.9% overall accuracy. [A + N + S] was particularly advantageous for locating PTA in the lower weight quartiles. Conclusions Native CT-phase and dual time point Sestamibi SPECT increase specificity and sensitivity, respectively. These, in combination with a single contrast-enhanced CT-phase is the most optimal examination protocol for preoperative localisation of PTA using SPECT/CT.

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Section: Discussionmentioning

confidence: 97%

The preoperative localisation of small parathyroid adenomas improves when adding Tc-99m-Sestamibi SPECT to multiphase contrast-enhanced CT

et al. 2021

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“…The cost effectiveness of ioPTH monitoring in MIP is also among the topics of discussion. In a recent multicentric European study, it has been reported that ioPTH is not costeffective in cases with positive and concordant scans, and may even increase the conversion rate by 2.7% due to false negativity (15). Morris et al examined 4,280 patients in 17 studies and applied a model to predict the cost effectiveness and probability of ioPTH in patients with localized pHPT.…”

Section: Discussionmentioning

confidence: 99%

“…The cost effectiveness of ioPTH monitoring in MIP is also among the topics of discussion. In a recent multicentric European study, it has been reported that ioPTH is not cost-effective in cases with positive and concordant scans, and may even increase the conversion rate by 2.7% due to false negativity ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

“…In most of the studies, it has been reported that ioPTH does not increase the cure rate of MIP and is not necessary in patients with concordant scans ( 10 – 12 ). In patients with concordant scans, ioPTH may increase operative time, cost, and even the conversion rate due to false-negative results due to insufficient decrease in ioPTH ( 13 – 15 ).…”

Section: Introductionmentioning

confidence: 99%

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Contribution of intraoperative parathyroid hormone monitoring to the surgical success in minimal invasive parathyroidectomy

et al. 2022

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BackgroundThe contribution of intraoperative parathyroid hormone monitoring to minimally invasive parathyroidectomy remains controversial. We aimed to evaluate whether intraoperative parathyroid hormone monitoring monitoring could contribute to minimally invasive parathyroidectomy in these patients.MethodsThe data of the patients whose preoperative ultrasonography and technetium-99 m sestamibi scintigraphy imagings were positive and concordant for one gland and who underwent minimally invasive parathyroidectomy between 2003 and 2018 in our clinic, were evaluated retrospectively. Blood samples were collected at pre-excisional period, and at post-excisional 10 and 20 min; the intaoperative parathyroid hormone was measured, and the surgery was terminated without waiting for the result. Patients were divided into 2 groups according to the postoperative results, as those with normocalcemia (Group 1) and those with persistence (Group 2).ResultsThere were 195 patients in Group 1 and 14 patients in Group 2. The cure rate at the first surgery was 93.3%. Cure was achieved after the second operation in all patients in Group 2. Recurrent disease developed in 1 patient in group 1 and the overall cure rate was 99.5%. If intraoperative parathyroid hormone had been evaluated, cure could have been achieved at the first surgery with additional exploration, in 10 (71.4%) of 14 patients according to the insufficient decrease in parathyroid hormone value at the 10 min in Group 2, and in 9 (64.3%) of 14 patients according to the parathyroid hormone value at 20 min. However, due to insufficient decrease (false negative) in the parathyroid hormone value at the 10 and 20 min the rate of false negatives and unnecessary exploration would be 9.5% and 2.5%, respectively. With additional exploration, the cure rate in the first surgery could be increased by 4.3%–97.6% according to the 20 min intraoperative parathyroid hormone value.ConclusionThe cure rate in minimally invasive parathyroidectomy can be increased by minimizing unnecessary conversion to bilateral neck exploration, by evaluating intraoperative parathyroid hormone at 10 min in patients with positive and concordant scans, and intraoperative parathyroid hormone at 20 min in patients with inadequate decrease at 10 min intraoperative parathyroid hormone.

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“…The introduction of ioPTH and the optimization of its interpretative models, together with the refinement of techniques for localization of pathological parathyroid glands have allowed the implementation of focused approach for PTx 13 , 14 and the extension of surgical indications, with an overall improvement of treatment optimization, especially in terms of complications of HPT1 15 . In addition, ioPTH may be a useful tool in difficult settings, such as concurrent thyroid disease or unlocalized parathyroid gland 16 , 17 .…”

Section: Introductionmentioning

confidence: 99%

Interpretation of intraoperative parathyroid hormone monitoring according to the Rome criterion in primary hyperparathyroidism

Graceffa

Cipolla

Calagna

et al. 2022

Sci Rep

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Intraoperative parathyroid hormone dosage allows real-time monitoring of the decrease in PTH levels during parathyroidectomy and verify procedure’s efficacy. Currently, none of the interpretative criteria used has absolute accuracy. The aim of this study is to evaluate diagnostic accuracy of the Rome criterion verifying diagnostic significance of the individual assays. A total of 205 patients with primary hyperparathyroidism from a single adenoma were retrospectively evaluated and monitored with baseline PTH, PTH at 10 min and PTH at 20 min after adenoma excision. The accuracy of the latter two assays compared with baseline was compared by ROC curves. In addition, was evaluated the influence on these data of localization diagnostics (ultrasounds and scintigraphy), definitive histology, and type of surgery performed. The ratio of 20-min sampling to baseline in the Rome criterion showed highest diagnostic significance. This finding was not influenced by the type of surgery performed, definitive histologic examination, or intraoperative localization of the adenoma. The Rome criterion has shown its high reliability in detecting persistence. The ratio of sampling at 20 min to baseline is by far the best performing. Further studies are needed to evaluate whether sampling at 10 min after adenoma excision can be considered not mandatory.

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European multicentre study on outcome of surgery for sporadic primary hyperparathyroidism

Cited by 29 publications

References 24 publications

The preoperative localisation of small parathyroid adenomas improves when adding Tc-99m-Sestamibi SPECT to multiphase contrast-enhanced CT

The preoperative localisation of small parathyroid adenomas improves when adding Tc-99m-Sestamibi SPECT to multiphase contrast-enhanced CT

Contribution of intraoperative parathyroid hormone monitoring to the surgical success in minimal invasive parathyroidectomy

Interpretation of intraoperative parathyroid hormone monitoring according to the Rome criterion in primary hyperparathyroidism

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