Parathyroid Hormone Venous Sampling Before Reoperative Surgery in Renal Hyperparathyroidism

Abstract

To analyze the predictive values of selective venous sampling (SVS) in our own experience and in a systematic meta-analysis of the international literature and to compare them with the results of noninvasive localization studies before reoperative parathyroid surgery. Data Sources: Twenty-one consecutive patients with persistent or recurrent renal hyperparathyroidism underwent preoperative SVS and noninvasive imaging. These data were added to a systematic review of the literature on localization studies before reoperative surgery. The literature search included localization studies, recurrent hyperparathyroidism, and reoperation. Study Selection: Prospective and retrospective studies that provided at least the true-positive rate of 1 procedure were included. Data from initial surgery, hyperfunctioning autografts, and case reports were excluded.

Influence of Surgical Volume on Operative Failures for Hyperparathyroidism

“…Sestamibi scintigraphy is another commonly used noninvasive technique for localizing parathyroid tissue and can visualize glands in ectopic locations (Figure 2). Similar to neck ultrasounds, the sensitivity and positive predictive value of sestamibi is variable, but can reach 90% and 100% respectively 25,26 . For glands that can not be localized by ultrasound or sestamibi scanning, either computed tomography (CT) scanning, magnetic resonance imaging (MRI), or positron emission tomography (PET) can be utilized.…”

“…Ultrasound can visualize intra-thyroidal parathyroid glands and those in the area of the carotid sheath and jugular vein, but glands which are retroesophageal or retrotracheal are difficult to localize (Figure 1). The sensitivity and positive predictive value of ultrasound varies depending on operator experience, size of the parathyroid gland, and image resolution, but have been found to be as high as 86% and 100% respectively 25,26 . Sestamibi scintigraphy is another commonly used noninvasive technique for localizing parathyroid tissue and can visualize glands in ectopic locations (Figure 2).…”

Parathyroid Cancer: A Review

“…If these tests are inconclusive, there is a role for selective venous catheterization and sampling to assay PTH levels. This usually occurs if at least two separate complementary imaging studies have been used and the tumor is still not able to be identified [80].…”

Imaging diagnostics for primary hyperparathyroidism

“…-In light of the available data, it seems that patients with primary hyperparathyroidism should receive USG of the neck and scintigraphy MIBI in the first place to identify the lesions [54][55][56][57][58]. If any discrepancies occur in the results, MR is recommended.…”