Selective parathyroid venous sampling in primary hyperparathyroidism: A systematic review and meta‐analysis

Ibraheem, Kareem; Toraih, Eman A.; Haddad, Antoine; Farag, Mahmoud M.; Randolph, Gregory W.

doi:10.1002/lary.27213

Cited by 26 publications

(23 citation statements)

References 39 publications

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“…Occasionally, both ultrasound and 99m Tcsestamibi-SPECT/CT scans fail to localise the lesion and additional procedures may be necessary. More recently, 4D CT has been used in such cases [55], thus avoiding invasive procedures such as surgical neck exploration [56] or selective parathyroid venous sampling [57]. A recent study showed that among six patients where 99m Tc-sestamibi-SPECT/CT did not localise the lesion, surgeon-performed peri-operative ultrasound scans successfully located the parathyroid adenoma in three (50%) patients [41].…”

Section: Discussionmentioning

confidence: 99%

A clinical perspective of parathyroid hormone related hypercalcaemia

Han¹,

Fry

Sharma

et al. 2019

Rev Endocr Metab Disord

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There are many causes of hypercalcaemia including hyperparathyroidism, drugs, granulomatous disorders and malignancy. Parathyroid hormone (PTH) related hypercalcaemia is most commonly caused by primary hyperparathyroidism (PHPT) and more rarely by familial hypocalciuric hypercalcaemia (FHH). Algorithms for diagnosis of PTH related hypercalcaemia require assessment of a 24-h urinary calcium and creatinine excretion to calculate calcium/creatinine clearance ratio and radiological investigations including ultrasound scan and 99m Tc-sestamibi-SPECT/CT. To illustrate investigations and management of parathyroid-related hypercalcaemia, we present a selection of distinct cases of PHPT due to eutopic and ectopic parathyroid adenomas, as well as a case with a syndromic form of PHPT (multiple endocrine neoplasia type 1), and a case with FHH type 1 due to a CASR inactivating mutation. Additional cases with normocalcaemic hyperparathyroidism and secondary hyperparathyroidism are included for completeness of differential diagnosis. The common eutopic parathyroid adenomas are easily treated with parathyroidectomy while the less common ectopic parathyroid adenomas require more complex investigations and operative procedures such as video-assisted thoracoscopic surgery. On the other hand, the much less common FHH does not require treatment. Assessment of kin with FHH is important to identify members with this inherited condition in order to prevent unnecessary interventions.

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Section: Discussionmentioning

confidence: 99%

A clinical perspective of parathyroid hormone related hypercalcaemia

Han¹,

Fry

Sharma

et al. 2019

Rev Endocr Metab Disord

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“…SSVS obtains samples from smaller neck and upper chest veins (e.g., superior, middle, and inferior thyroid veins; main inferior thyroid trunk; thymic vein; superior intercostal veins; and occasionally internal mammary veins) to enable more precise localization of parathyroid pathology. In the reoperative setting, meta-analysis of SSVS has found a pooled sensitivity of 90% for localizing parathyroid adenomas [96]. Among reoperative patients with inconclusive first-line imaging, SSVS has a sensitivity of 96% and a PPV of 84%, which is significantly more accurate than routine SVS [97].…”

Section: Selective Venous Samplingmentioning

confidence: 99%

“…A PTH level in a selected vein at least twice the systemic level is considered localizing for abnormal parathyroid glands. A 2018 metaanalysis of SVS in both de novo (minority) and reoperative (majority) patients reported a pooled sensitivity of 74% for localizing parathyroid adenomas [96]. Among reoperative patients with inconclusive noninvasive imaging studies, the sensitivity of SVS ranges from 75 to 93% [1,6,41,72].…”

Section: Selective Venous Samplingmentioning

confidence: 99%

“…e benefits of invasive localization should be measured against its costs and limitations. Meta-analysis has shown that SVS is more sensitive than noninvasive imaging modalities at localizing adenomas in patients with pPHPT or rPHPT undergoing reoperation [96]. Yet, this higher sensitivity of SVS may be attributable to the fact that the patients enrolled in comparative studies only underwent invasive imaging because their noninvasive imaging studies were inconclusive to begin with.…”

Section: Selective Venous Samplingmentioning

confidence: 99%

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Localization of Parathyroid Disease in Reoperative Patients with Primary Hyperparathyroidism

Parikh

Grogan

Morón

2020

International Journal of Endocrinology

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The localization of persistent or recurrent disease in reoperative patients with primary hyperparathyroidism presents challenges for radiologists and surgeons alike. In this article, we summarize the relevant imaging modalities, compare their accuracy in identifying reoperative disease, and outline their advantages and disadvantages. Accurate localization by preoperative imaging is a predictor of operative success, whereas negative or discordant preoperative imaging is a risk factor for operative failure. Ultrasound is a common first-line modality because it is inexpensive, accessible, and radiation-free. However, it is highly operator-dependent and less accurate in the reoperative setting than in the primary setting. Sestamibi scintigraphy is superior to ultrasound in localizing reoperative disease but requires radiation, prolonged imaging times, and reader experience for accurate interpretation. Like ultrasound, sestamibi scintigraphy is less accurate in the reoperative setting because reoperative patients can exhibit distorted anatomy, altered perfusion of remaining glands, and interference of radiotracer uptake. Meanwhile, four-dimensional computed tomography (4DCT) is superior to ultrasound and sestamibi scintigraphy in localizing reoperative disease but requires the use of radiation and intravenous contrast. Both 4DCT and magnetic resonance imaging (MRI) do not significantly differ in accuracy between unexplored and reoperative patients. However, MRI is more costly, inaccessible, and time-consuming than 4DCT and is inappropriate as a first-line modality. Hybrid imaging with positron emission tomography and computed tomography (PET/CT) may be a promising second-line modality in the reoperative setting, particularly when first-line modalities are discordant or inconclusive. Lastly, selective venous sampling should be reserved for challenging cases in which noninvasive modalities are negative or discordant. In the challenging population of reoperative patients with PHPT, a multimodality approach that utilizes the expertise of high-volume centers can accurately localize persistent or recurrent disease and enable curative parathyroidectomy.

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“…оттока, в результате селективной катетеризации внутренних яремных, брахиоцефальных и/или вен щитовидной железы относительно периферических вен. По некоторым данным, чувствительность метода достигает 94%, а специфичность приближается к 100% [63,64]. На сегодняшний день в широкой практике не используется, учитывая риск осложнений и высокую информативность менее инвазивных методов диагностики.…”

Section: другие (инвазивные) диагностические методыunclassified

Imaging methods of the parathyroid glands in primary hyperparathyroidism. Literature review

Slashchuk¹,

Degtyarev²,

Rumyantsev³

et al. 2020

Endo Serg

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Primary hyperparathyroidism (PHPT) is a common endocrine disease that occurs with multiple profiles in which no classical manifestation. Diagnosis revolves around routine measurement of serum calcium and parathyroid hormone more than in half cases. The understanding of clinical presentation, epidemiology and management tactics of patients with hyperparathyroidism has significantly changed by virtue of the use of biochemical calcium screening. The successful diagnosis and treatment are possible with the cooperation of a multidisciplinary team of endocrinologist, endocrine surgeon, radiologist, nuclear medicine physician and pathomorphologist. The only radical method of treatment is the surgical removal of abnormal parathyroid glands. In this regard, there is necessary to improve the parathyroid glands imaging algorithms. Early treatment of hyperparathyroidism allows to avoid severe damage to the bones, kidneys, heart, other organs, improving the quality of life and reducing the incidence of disability. For a systematic literature review, more than 100 articles published from 2000 to the present time were used, on following resources: PubMed, Embase, SciSearch, Scopus, Cochrane Databases, Research Gate, Google Scholar. Including recommendations from the American Association of Endocrinologists and Endocrine Surgeons (AACE/AAES), European Society of Nuclear Medicine (EANM), European Society ofEndocrinologists (ESE), Russian Association of Endocrinologists (RAE) and several other organizations. The main goal of this review is to summarize and present relevant information and a new look on preoperative imaging techniques, methods of intraoperative navigation, surgery, control quality of treatment in patients with primary hyperparathyroidism.

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Selective parathyroid venous sampling in primary hyperparathyroidism: A systematic review and meta‐analysis

Cited by 26 publications

References 39 publications

A clinical perspective of parathyroid hormone related hypercalcaemia

A clinical perspective of parathyroid hormone related hypercalcaemia

Localization of Parathyroid Disease in Reoperative Patients with Primary Hyperparathyroidism

Imaging methods of the parathyroid glands in primary hyperparathyroidism. Literature review

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