Parathyroid Cancer: A Review

Machado, Nikita Neha; Wilhelm, Scott M.

doi:10.3390/cancers11111676

Cited by 57 publications

(70 citation statements)

References 85 publications

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“…Serum Ca, serum PTH, and border of lesion are signi cant factors for the differential diagnosis among them. Our study is in line with previous studies that the median serum PTH in parathyroid cancer is commonly much higher than serum PTH in other causes of PHPT, which would be 5 to 10 times higher than the upper limit of the norm [18]. The median serum Ca in parathyroid adenoma was lower than those in parathyroid cancer and parathyroid hyperplasia.…”

Section: Discussionsupporting

confidence: 92%

Differential Diagnostic Value of Parathyroid 99mTc-MIBI SPECT/CT in MIBI Uptake Lesion

Liu

Sen

et al. 2020

Preprint

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Background: To investigate the role of parathyroid technetium-99m-hexakis2-methoxy-2-methylpropylisonitrile (99mTc-MIBI) single photon emission computed tomography/ computed tomography (SPECT/CT) combined with the serum calcium (Ca) and serum parathyroid hormone (PTH) in the differential diagnosis of MIBI uptake lesion. Methods: 201 patients with MIBI uptake lesion on parathyroid 99mTc-MIBI SPECT/CT from January 2015 to July 2019 were enrolled in this study. All patients who underwent surgical resection were classified into two groups: primary hyperparathyroidism (PHPT) and non-PHPT in terms of the pathological findings. Radiological performance of 99mTc-MIBI SPECT/CT, serum Ca and serum PTH were comparable between the two groups.Results: 201 patients (135 females; median age, 53.0 years; age range, 29 – 79 years) were included. Pathological findings were as follows: PHPT was in 126 (62.7%) patients, including parathyroid adenoma in 106 patients, parathyroid cancer in 12 patients and parathyroid hyperplasia in 8 patients, while non-PHPT were in 75 (37.3%) patients, including thyroid adenoma in 14 patients, thyroid papillary cancer in 15 patients and thyroid nodular goiter in 46 patients. In the following multivariable logistic regression analysis, serum Ca and diameter of the shortest axis of the lesion were the independent factors for differentiating PHPT from non-PHPT. In receiver operating characteristic (ROC) analyses, the cut-off value of serum Ca differentiating PHPT from non-PHPT was 2.6 mmol/L, yielding the area under the ROC curve (AUC) of 0.931, sensitivity of 85.7%, specificity of 89.2%; the cut-off value of diameter of the shortest axis of the lesion was 20.4mm, yielding AUC of 0.728, sensitivity of 62.2%, specificity of 87.1%.Conclusion: Parathyroid 99mTc-MIBI SPECT/CT combined with serum Ca and serum PTH contributed to the differential diagnosis of PHPT from non-PHPT, evenly can assist the determination of the specific pathology of MIBI uptake lesion before surgery.

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Section: Discussionsupporting

confidence: 92%

Differential Diagnostic Value of Parathyroid 99mTc-MIBI SPECT/CT in MIBI Uptake Lesion

Liu

Sen

et al. 2020

Preprint

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“…The diagnosis of parathyroid carcinoma preoperatively is difficult due to a definite symptomatology overlap between benign and malignant PHPT. Reportedly, patients with malignant PHPT presented serum PTH concentrations 5-10 times the upper limit of normal (18) compared to those with benign PHPT, who had serum PTH values within 2 times above the reference range (5). Likewise, hypercalcemic crisis (>3.5 mmol/L) is usually found in up to 10% of patients with parathyroid carcinoma (34), as opposed to patients with parathyroid adenoma or hyperplasia, whose serum calcium levels are generally at most 0.25 mmol/L above the upper limit of normal (5).…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Primary Hyperparathyroidism: 15-Year Experience of 457 Patients in a Single Center in China

et al. 2021

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ObjectivePrimary hyperparathyroidism (PHPT) is a common endocrine disorder of calcium metabolism. However, data concerning a large cohort of PHPT patients in the Chinese population are scarce. Thus, the objective of this study was to determine the general clinical signatures of 457 Chinese PHPT patients and explore the clinical characteristic differences between benign and malignant PHPT.MethodsA single-center retrospective study was designed. Medical records between preoperation and postoperative follow-up, were assessed and statistical analysis of the clinical data was performed.ResultsPatients with PHPT aged 12–87 years, with a mean onset age of 56.16 ± 14.60 years, were included. Most patients (68.7%) in our center had symptomatic patterns described as bone pain (74.8%), urolithiasis (25.5%), fatigue (17.5%), and pathological fracture (13.1%), but an increasing tendency has been established in the proportion of patients with asymptomatic forms. Correlation analysis revealed that patients with higher serum levels of parathyroid hormone (PTH) and calcium presented higher serum levels of bone turnover markers (BTMs) and lower 25-hydroxy-vitamin D (25OHD) values (P<0.001). Gains in bone mineral density (BMD) at L1–4, the femoral neck and the total hip were observed 1–2 years after parathyroidectomy (9.6, 5.9, and 6.8%). Parathyroid carcinoma patients presented prominently higher serum PTH and calcium levels and BTMs and lower BMD at femoral neck and total hip than benign PHPT patients (P<0.05), while no significant differences in age, sex, and serum 25OHD concentration were observed between benign and malignant PHPT patients.ConclusionsPHPT should be paid attention to in the patients with bone pain. While, BMD and BTMs can differentiate parathyroid carcinoma from parathyroid adenoma and hyperplasia to some extent. In addition, anti-osteoporosis drugs could be used when necessary to avoid hip fractures in patients with parathyroid carcinoma.

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“…The prevalence of PHPT is 1:1000 [4,5]. Impaired PTH production might result from various parathyroid abnormalities such as adenoma, cancer, hyperplasia or neoplasia [6,7] circulating levels of PTH may also be caused by parathyroid carcinoma (though in rare cases (1-2%)), but more often because of diffuse parathyroid hyperplasia (around 15%), and single or multiple autonomously functioning parathyroid adenomas (up to 85%) [8][9][10]. Thence, interrupted calcium homeostasis leads to further imbalances of other elements in the organism [11,12].…”

Section: Introductionmentioning

confidence: 99%

Preoperative and Intraoperative Methods of Parathyroid Gland Localization and the Diagnosis of Parathyroid Adenomas

et al. 2020

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Accurate pre-operative determination of parathyroid glands localization is critical in the selection of minimally invasive parathyroidectomy as a surgical treatment approach in patients with primary hyperparathyroidism (PHPT). Its importance cannot be overemphasized as it helps to minimize the harmful side effects associated with damage to the parathyroid glands such as in hypocalcemia, severe hemorrhage or recurrent laryngeal nerve dysfunction. Preoperative and intraoperative methods decrease the incidence of mistakenly injuring the parathyroid glands and allow for the timely diagnosis of various abnormalities, including parathyroid adenomas. This article reviews 139 studies conducted between 1970 and 2020 (49 years). Studies that were reviewed focused on several techniques including application of carbon nanoparticles, carbon nanoparticles with technetium sestamibi (99m Tc-MIBI), Raman spectroscopy, near-infrared autofluorescence, dynamic optical contrast imaging, laser speckle contrast imaging, shear wave elastography, and indocyanine green to test their potential in providing proper parathyroid glands’ localization. Apart from reviewing the aforementioned techniques, this study focused on the applications that helped in the detection of parathyroid adenomas. Results suggest that applying all the reviewed techniques significantly improves the possibility of providing proper localization of parathyroid glands, and the application of indocyanine green has proven to be the ‘ideal’ approach for the diagnosis of parathyroid adenomas.

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Parathyroid Cancer: A Review

Cited by 57 publications

References 85 publications

Differential Diagnostic Value of Parathyroid 99mTc-MIBI SPECT/CT in MIBI Uptake Lesion

Differential Diagnostic Value of Parathyroid 99mTc-MIBI SPECT/CT in MIBI Uptake Lesion

Clinical Characteristics of Primary Hyperparathyroidism: 15-Year Experience of 457 Patients in a Single Center in China

Preoperative and Intraoperative Methods of Parathyroid Gland Localization and the Diagnosis of Parathyroid Adenomas

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