Minimal‐access parathyroid surgery using intraoperative parathyroid hormone assay

Sofferman, Robert A.; Standage, Jeanette; Tang, Mary E.

doi:10.1097/00005537-199810000-00013

Cited by 72 publications

(37 citation statements)

References 10 publications

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“…If both reliable preoperative localizing tests and 66 www.endocrinology.org intraoperative quick-PTH assay are available, minimally invasive parathyroidectomy becomes a safe alternative procedure to bilateral neck exploration, and the most common causes of parathyroidectomy failure may be eliminated (Soffermann et al 1998, Boggs et al 1999, Chen et al 1999. Selective venous sampling is of little usefulness in the noninvasive era and should be abandoned because of its low sensitivity (41-65%) and positive predictive value, longer technical performing and high cost, and might be useful only in selected patients with persistent or recurrent hyperparathyroidism (Doppman et al 1998, Pattou et al 1999.…”

Section: Discussionmentioning

confidence: 99%

Localization of parathyroid tumours in the minimally invasive era: which technique should be chosen? Population-based analysis of 253 patients undergoing parathyroidectomy and factors affecting parathyroid gland detection.

Lumachi¹,

Ermani²,

Basso³

et al. 2001

Endocrine-Related Cancer

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A series of 253 consecutive patients with proved primary hyperparathyroidism due to parathyroid tumours was reviewed. There were 68 (26.9%) men and 185 (73.1%) women, with a median age of 57 years (range 13-82 years). All patients, prior to successful parathyroidectomy, underwent one or more preoperative localization procedures such as: neck ultrasonography (US) in 191 (75.5%), 201 Tl/ 99m Tc-pertechnetate subtraction scintigraphy (TPS) in 144 (56.9%), CT scan in 92 (36.4%), 99m Tc-sestamibi/ 99m Tc-pertechnetate subtraction scintigraphy (MPS) in 90 (35.6%), selective venous sampling (SVS) with parathyroid hormone (PTH) assay in 30 (11.9%), and magnetic resonance imaging (MRI) in 6 (2.4%) patients. The results were compared with operative and histological findings that showed 235 (92.9%) solitary parathyroid adenomas, 13 (5.1%) carcinomas and 5 (2.0%) double adenomas. Sensitivity and positive predictive value were 82.9% and 93.8% for US, 83.6% and 91.8% for TPS, 81.3% and 98.7% for CT scan, 85.1% and 96.1% for MPS, 65.4% and 80.9% for SVS, and 80.0% and 80.0% for MRI respectively. No different results (P = NS) were found using US, TPS, MPS or CT scan, whereas SVS and MRI sensitivity was lower (P < 0.05). The combination of MPS and US was 94.0% sensitive (P < 0.05) but when TPS, CT scan or MRI were also used overall sensitivity did not improve significantly (P = NS). In conclusion, MPS should be used as the starting preoperative localization procedure, while US and MPS together represent the most reliable noninvasive localization tool. If MPS and US are negative or not in agreement, further studies are not cost-effective and the patient should undergo bilateral neck exploration.

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Section: Discussionmentioning

confidence: 99%

Localization of parathyroid tumours in the minimally invasive era: which technique should be chosen? Population-based analysis of 253 patients undergoing parathyroidectomy and factors affecting parathyroid gland detection.

Lumachi¹,

Ermani²,

Basso³

et al. 2001

Endocrine-Related Cancer

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“…After excision of each abnormal PT gland, an intraoperative PTH assay represents the principal determinant of correction of the hyperparathyroid state and should be available for all patients with pHPT undergoing surgery (42,48,49). In most studies, routine use of 99m Tc-sestamibi scintigraphy, neck ultrasonography and quick-PTH measurement was considered safe and cost-effective, significantly reducing operative time, facilitating successful limited neck exploration and improving the success rate of PTx, Table 3 Results obtained in patients with PT tumors localized in typical (n = 66) and ectopic (n = 17) sites using SS and US.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors estimated that US and PT scintigraphy charges accounted for only 2% and 5% respectively of the total charges for PTx, and that the added cost of protracted or failed exploration neutralized the costs of SS and US which are equivalent to 60 min operative time or less (13,48,53). In spite of that some surgeons, on account of low sensitivity obtained with preoperative localization procedures in their experience, consider imaging of the PT glands unnecessary and recommend a careful bilateral neck exploration in all patients with pHPT (6,8,54).…”

Section: Scintigraphy Ultrasonographymentioning

confidence: 99%

Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism

Lumachi

Zucchetta

Marzola

et al. 2000

European Journal of Endocrinology

145

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Objective: To evaluate the usefulness of the combination of 99m Tc-sestamibi/ 99m Tc-pertechnetate subtraction scintigraphy (SS) and high-resolution neck ultrasonography (US) in patients with primary hyperparathyroidism (pHPT) undergoing parathyroidectomy. Design and Methods: Ninety-one patients with proved pHPT were studied, excluding patients with persistent or recurrent disease. There were 65 (71.4%) women and 26 (28.6%) men, with a median age of 59 years (range 18±78 years). All patients underwent both SS and US prior to surgery, and the results were compared with operative and histological findings. The intraoperative quick-parathyroid hormone assay was available for 52 (57.1%) patients. When multiglandular disease was found, both SS and US were considered truly positive only when at least two enlarged parathyroid (PT) glands had been localized. Results: Eighty-three (91.2%) solitary PT adenomas and three (3.3%) carcinomas were found. Moreover, two (2.2%) patients had a double adenoma and three (3.3%) patients had diffuse PT hyperplasia. The overall sensitivity of combined SS US was 94.5% (86.8% and 80.4% for SS and US respectively). There was a significant P , 0X05Y Student's t-test) difference in size between the PT glands correctly identified and undetected by SS, whereas the site of the removed PT tumors significantly P , 0X05Y Fisher exact test) influenced only the US sensitivity. Conclusions: When the preoperative localization of the PT glands is chosen, the combination of SS and US represents a reliable noninvasive localization technique and should be considered for use in each patient with pHPT undergoing surgery.

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“…The rapid intra-operative parathyroid hormone assay (RI-PTH) is transforming the parathyroidectomy procedure. The visualization of all parathyroids glands and resection of apparently enlarged gland(s) has increasingly been replaced by minimally invasive (unilateral) surgical procedures (MIP), supported by pre-operative imaging aid and RI-PTH measurements [2][3][4][5][6][7][8][9][10]. In most cases, the improved imaging techniques enable exact pre-operative localization of the parathyroid adenoma [11].…”

Section: Introductionmentioning

confidence: 99%

Parathyroidectomy monitored by intra-operative PTH: The relevance of the 20 min end-point

Stasio

Carrozza

Lombardi

et al. 2007

Clinical Biochemistry

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Minimal‐access parathyroid surgery using intraoperative parathyroid hormone assay

Abstract: Intraoperative PTH assay has added a new dimension to primary and revision parathyroid surgery. It is cost-effective and accurate and may reduce the morbidity of surgical intervention in revision procedures.

Cited by 72 publications

References 10 publications

Localization of parathyroid tumours in the minimally invasive era: which technique should be chosen? Population-based analysis of 253 patients undergoing parathyroidectomy and factors affecting parathyroid gland detection.

Localization of parathyroid tumours in the minimally invasive era: which technique should be chosen? Population-based analysis of 253 patients undergoing parathyroidectomy and factors affecting parathyroid gland detection.

Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism

Parathyroidectomy monitored by intra-operative PTH: The relevance of the 20 min end-point

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