Reoperative parathyroidectomy in the era of localization technology

Rotstein, Lorne; Irish, John C.; Gullane, Patrick; Keller, Marc; Sniderman, Kenneth W.

doi:10.1002/(sici)1097-0347(199809)20:6<535::aid-hed8>3.0.co;2-8

Cited by 53 publications

(27 citation statements)

References 12 publications

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“…In keeping with previous observations, this study shows the better performance of SVS in the accurate detection of residual pathological parathyroid tissue prior to revision surgery compared with that of the widely used Tc99m-MIBI-SPECT (15)(16)(17). In our hands, SVS was indeed able to accurately localize 71% of the pathological glands missed by Tc99m-MIBI-SPECT.…”

Section: Discussionsupporting

confidence: 89%

“…To date, Tc99m-MIBI-SPECT and US of the neck are the most widely used imaging techniques with a sensitivity of up to 90% prior to initial surgery for PHPT (1-5, 7, 10, 35). However, the sensitivity of these techniques has been reported to be as low as 50% before revision surgery for persistent PHPT (15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

“…The most widely used localization study, Tc99m-methoxy-isobutyle-isonitrile (MIBI)-single photon emission computed tomography (SPECT), has indeed been shown to hold significant limitations prior to revision surgery for persistent PHPT. Explanations for the poor localizing ability of Tc99m-MIBI-SPECT in persistent PHPT, as low as 50%, include the small size of residual pathological glands, higher probability of hyperplasia, and the potential distortion of the vascular supply to the residual hyperactive glands due to previous surgery (15)(16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

“…Variations in regional venous drainage may also occur as a result of previous surgical interventions, usually due to ligation of draining veins. In previously published studies, the predictive value of SVS was judged to be positive when a positive gradient was documented on the side of the neck where a pathological gland was found at subsequent surgery (15,27,29). The aim of this study is to evaluate whether SVS for PTH could contribute to a more accurate preoperative localization of residual hyperactive parathyroid tissue in patients with persistent hyperparathyroidism.…”

Section: Introductionmentioning

confidence: 99%

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The role of selective venous sampling in the management of persistent hyperparathyroidism revisited

Witteveen¹,

Kievit²,

Erkel³

et al. 2010

European Journal of Endocrinology

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Introduction: Localization studies are mandatory prior to revision surgery in patients with persistent hyperparathyroidism in order to improve surgical outcome and reduce the risk of lengthy explorations. However, in this case, noninvasive localization studies are reported to have a poor sensitivity. The aim of our study is to determine the accuracy of selective venous sampling (SVS) for parathyroid hormone (PTH) in localizing residual hyperactive parathyroid glands in patients with persistent or recurrent hyperparathyroidism. Patients and methods: We retrospectively evaluated the localizing accuracy of 20 PTH SVS performed prior to revision surgery in 18 patients with persistent or recurrent primary hyperparathyroidism (nZ11) or autonomous (tertiary) hyperparathyroidism (nZ7). Tc99m-methoxy-isobutyle-isonitrile (MIBI)-single photon emission computed tomography (SPECT) was also performed in all patients prior to revision surgery. Operative and pathological data were obtained from hospital records. Results: The SVS was able to accurately localize 15 of the 20 pathological glands removed at revision surgery, representing a sensitivity of 75%. This sensitivity is significantly higher than that of Tc99m-MIBI-SPECT, which was only 30% (PZ0.012).Conclusion: Our findings demonstrate that SVS is a valuable localization study in patients with persistent or recurrent hyperparathyroidism, with a sensitivity significantly higher than that of Tc99m-MIBI-SPECT. Our data suggest that SVS represents a useful addition to the preoperative workup of these patients prior to revision surgery.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The role of selective venous sampling in the management of persistent hyperparathyroidism revisited

Witteveen¹,

Kievit²,

Erkel³

et al. 2010

European Journal of Endocrinology

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“…The non-invasive techniques used for this include ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), sestamibi scintigraphy (MIBI), and methionine-PET). Before reoperation, the sensitivity of US, CT, MRI, MIBI, and methionine-PET has been reported at 20-80 % (7-11), 40-90 % (9,11,12), 65-80 % (8,11,12), 50-90 % (8,9,(11)(12)(13), and about 80% (14), respectively.…”

Section: Introductionmentioning

confidence: 99%

Super-selective venous sampling in conjunction with quickPTH for patients with persistent primary hyperparathyroidism: report of five cases

Gimm

Arnesson²,

Olofsson³

et al. 2012

Surg Today

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Parathyroid Hormone Venous Sampling Before Reoperative Surgery in Renal Hyperparathyroidism

Seehofer¹

2004

Arch Surg

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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.

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Reoperative parathyroidectomy in the era of localization technology

Cited by 53 publications

References 12 publications

The role of selective venous sampling in the management of persistent hyperparathyroidism revisited

The role of selective venous sampling in the management of persistent hyperparathyroidism revisited

Super-selective venous sampling in conjunction with quickPTH for patients with persistent primary hyperparathyroidism: report of five cases

Parathyroid Hormone Venous Sampling Before Reoperative Surgery in Renal Hyperparathyroidism

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