Primary hyperparathyroidism with surgical indication and negative or equivocal scintigraphy: safety and reliability of PTH washout. A systematic review and meta-analysis

Castellana, Marco; Virili, Camilla; Palermo, Andrea; Giorgino, Francesco; Giovanella, Luca; Trimboli, Pierpaolo

doi:10.1530/eje-19-0160

Cited by 23 publications

(11 citation statements)

References 35 publications

(65 reference statements)

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“…The currently most widespread preoperative imaging procedure is the combination of [ 99m Tc]Tc-MIBI scintigraphy and cervical ultrasonography (cUS), yielding a sensitivity of 81-95% [21,22], which is mainly contributed by [ 99m Tc]Tc-MIBI scintigraphy. Cervical ultrasonography can be combined with targeted fine-needle aspiration (FNA) cytology and detection of PTH in the aspirate (FNA-PTH) in order to increase specificity and confirm the diagnosis of hyperfunctioning parathyroid lesions in sonographically accessible locations [23]. Fine-needle aspiration cytology is recommended in highly selected cases, e.g., atypical cUS presentation and uninformative [ 99m Tc]Tc-MIBI.…”

Section: Introductionmentioning

confidence: 99%

The EANM practice guidelines for parathyroid imaging

Ovčariček

Giovanella

Gasset

et al. 2021

Eur J Nucl Med Mol Imaging

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Introduction Nuclear medicine parathyroid imaging is important in the identification of hyperfunctioning parathyroid glands in primary hyperparathyroidism (pHPT), but it may be also valuable before surgical treatment in secondary hyperparathyroidism (sHPT). Parathyroid radionuclide imaging with scintigraphy or positron emission tomography (PET) is a highly sensitive procedure for the assessment of the presence and number of hyperfunctioning parathyroid glands, located either at typical sites or ectopically. The treatment of pHPT is mostly directed toward minimally invasive parathyroidectomy, especially in cases with a single adenoma. In experienced hands, successful surgery depends mainly on the exact preoperative localization of one or more hyperfunctioning parathyroid adenomas. Failure to preoperatively identify the hyperfunctioning parathyroid gland challenges minimally invasive parathyroidectomy and might require bilateral open neck exploration. Methods Over a decade has now passed since the European Association of Nuclear Medicine (EANM) issued the first edition of the guideline on parathyroid imaging, and a number of new insights and techniques have been developed since. The aim of the present document is to provide state-of-the-art guidelines for nuclear medicine physicians performing parathyroid scintigraphy, single-photon emission computed tomography/computed tomography (SPECT/CT), positron emission tomography/computed tomography (PET/CT), and positron emission tomography/magnetic resonance imaging (PET/MRI) in patients with pHPT, as well as in those with sHPT. Conclusion These guidelines are written and authorized by the EANM to promote optimal parathyroid imaging. They will assist nuclear medicine physicians in the detection and correct localization of hyperfunctioning parathyroid lesions.

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Section: Introductionmentioning

confidence: 99%

The EANM practice guidelines for parathyroid imaging

Ovčariček

Giovanella

Gasset

et al. 2021

Eur J Nucl Med Mol Imaging

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130

100

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“…al. 's 10 systematic review of 182 patients, the specificity and PPV of parathyroid FNA with PTH washout were 95% and 97%, respectively. They concluded that in patients with biochemically proven primary hyperparathyroidism and discordant imaging, parathyroid FNA was a safe and accurate procedure.…”

Section: Discussionmentioning

confidence: 98%

“…A number of studies showed excellent sensitivity (up to 95%) and positive predictive value (PPV, up to 100%) of PTH washout 10–15 ; and provided reassurance regarding the immediate safety of the procedure.…”

Section: Introductionmentioning

confidence: 98%

“…These circumstances include discordant imaging findings, [3][4][5] challenging anatomy (multinodular goiter or concomitant Hashimoto's thyroiditis), [6][7][8] intrathyroid adenoma, 9 and a history of neck surgery. 5 A number of studies showed excellent sensitivity (up to 95%) and positive predictive value (PPV, up to 100%) of PTH washout [10][11][12][13][14][15] ; and provided reassurance regarding the immediate safety of the procedure.…”

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confidence: 99%

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Parathyroid fine‐needle aspiration with parathyroid hormone washout as a preoperative localisation of parathyroid adenoma—A retrospective study

Klein,

Alsleibi,

Cohen

et al. 2023

Clinical Endocrinology

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Objective: The use of parathyroid lesion aspiration in preoperative adenoma localisation is controversial. Concerns have been raised regarding both immediate safety (hematoma, infection, alterations on a subsequent histologic preparate) and long-term safety (seeding).We aimed to evaluate the short-and long-term safety, and the efficacy, of parathyroid fine-needle aspiration with parathyroid hormone washout as a localisation modality of parathyroid adenoma in patients with primary hyperparathyroidism.Design: A retrospective study. Patients:The sample comprised 29 patients with primary hyperparathyroidism who underwent minimally invasive parathyroidectomy at a tertiary referral centre, following localisation with parathyroid hormone washout. Measurements:We reviewed all parathyroid hormone washout procedures performed during 2011-2021. Clinical, biochemical, and imaging information; and cytology, surgery, and pathology reports were extracted from electronic medical records.Results: Parathyroid hormone levels from the needle wash were 2.1-112.5 times the upper limit of the serum norm. Other than mild neck discomfort, no immediate procedure complications were documented. Fibrotic changes and necrosis were reported in two patients, with no effect on the final pathologic diagnosis or surgery course. No long-term complications (seeding, or parathyromatosis) were found. A total of 26 (90%) patients who were operated following a positive parathyroid hormone washout result were normocalcemic at the end of a mean 38.1-month follow-up period.Conclusions: Parathyroid fine-needle aspiration with parathyroid hormone washout was accurate. Immediate, surgical, or delayed complications were not demonstrated in our series. This approach might be considered for selected patients.

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“…Similar data were provided by Bancos et al who described immediate complications in 5% of performed P-FNAB [ 14 ]. Castellana et al did not find any major procedure-related complications in a large meta-analysis [ 24 ]. We had slightly more non-major complications, probably because of our standardized protocol with strict criteria (e.g., small skin hematomas were considered as minor complications) and double USG after P-FNAB procedure.…”

Section: Discussionmentioning

confidence: 99%

The Current Role of Parathyroid Fine-Needle Biopsy (P-FNAB) with iPTH-Washout Concentration (iPTH-WC) in Primary Hyperparathyroidism: A Single Center Experience and Literature Review

et al. 2022

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Introduction. Primary hyperparathyroidism (PHPT) is a condition characterized by disorders of calcium–phosphate metabolism and bone metabolism caused by pathological overproduction of parathyroid hormone (PTH). The diagnosis of overt PHPT is based on the presence of clinical symptoms and laboratory abnormalities typical of this condition: hypercalcemia, hypercalciuria and elevated iPTH levels. Imaging studies are not used for diagnostic purposes; they are performed to localize the parathyroid glands prior to potential surgical treatment. Technetium 99 m sestamibi scintigraphy (Tc99 m-MIBI) is the gold standard in the assessment of pathologically altered parathyroid glands. Other diagnostic options include cervical ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). Parathyroid biopsy (P-FNAB) with iPTH washout concentration (iPTH-WC) assessment is still an underestimated method of preoperative parathyroid gland localization. Few studies have reported the utility of US-guided P-FNAB in preoperative assessment of parathyroid lesions. The aim of the study was to present our experience with 143 P-FNAB with iPTH-WC assessment. Material and methods. Laboratory results, US findings, P-FNAB complications and comparison with other imaging techniques were described and analyzed. Results. In 133 (93.0) patients, iPTH washout-to-serum ratio exceeded threshold level 0.5 and were classified as positive results. Median iPTH-WC in this group was 16,856 pg/mL, and the iPTH-WC to serum iPTH ratio was 158. There was no correlation between iPTH-WC and serum PTH, serum calcium, parathyroid gland volume and shape index. In the group of 46 operated patients, 44 demonstrated positive iPTH-WC results, which corresponds to a sensitivity of 95.6%. In Tc99-MIBI, radiotracer retention was found in 17 cases (in 24 MIBI performed), which corresponds to a sensitivity of 52.2%. P-FNAB did not cause any major side effects −92.5% of all patients had no or mild adverse events after this procedure. Conclusions. P-FNAB with iPTH-WC is a reliable method in parathyroid adenoma localization during PHPT. Its sensitivity for diagnosis of PHPT is much higher than that of Tc99-MIBI, and in some situations, P-FNAB with iPTH-WC may even replace that method. Furthermore, cost-effectiveness of iPTH-WC is at least similar to that of Tc99-MIBI. Complications of P-FNAB are mild and we can describe this method as a safe procedure.

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Primary hyperparathyroidism with surgical indication and negative or equivocal scintigraphy: safety and reliability of PTH washout. A systematic review and meta-analysis

Cited by 23 publications

References 35 publications

The EANM practice guidelines for parathyroid imaging

The EANM practice guidelines for parathyroid imaging

Parathyroid fine‐needle aspiration with parathyroid hormone washout as a preoperative localisation of parathyroid adenoma—A retrospective study

The Current Role of Parathyroid Fine-Needle Biopsy (P-FNAB) with iPTH-Washout Concentration (iPTH-WC) in Primary Hyperparathyroidism: A Single Center Experience and Literature Review

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