Surgical management of primary hyperparathyroidism

Wang, Chiu-an

doi:10.1016/0011-3840(85)90019-x

Cited by 103 publications

(46 citation statements)

References 79 publications

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“…The mainstay of definitive surgical treatment of primary hyperparathyroidism has been routine bilateral neck exploration with attempt to identify 4 parathyroid glands (2). Over the last decade, there has been a trend for limited or unilateral surgical neck exploration with resection of the abnormal parathyroid gland with or without identification of an ipsilateral normal parathyroid gland (3).…”

mentioning

confidence: 99%

Preoperative ¹²³I/^99mTc-Sestamibi Subtraction SPECT and SPECT/CT in Primary Hyperparathyroidism

Neumann¹,

Obuchowski²,

DiFilippo³

2008

J Nucl Med

118

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The trend toward focused surgical parathyroidectomy requires precise preoperative localization of parathyroid lesions in patients with hyperparathyroidism. The purpose of this study was to directly compare the diagnostic accuracy of 99m Tc-sestamibi/ 123 I subtraction SPECT with SPECT/CT for the localization of abnormal parathyroid glands in patients with primary hyperparathyroidism. Methods: A total of 61 consecutive surgical patients with primary hyperparathyroidism underwent both 123 I/ 99m Tc-sestamibi subtraction SPECT and SPECT/CT scans preoperatively, using a hybrid SPECT/CT instrument that combined a dual-detector SPECT camera with a 6-slice multidetector spiral CT scanner. Four hours after being given 123 I-sodium iodide orally, each patient received 99m Tc-sestamibi intravenously, followed immediately by a simultaneous, dual-isotope SPECT scan of the neck and upper chest. Then, without moving the patient, we performed a noncontrast-enhanced CT scan of the same body region. Normalization and subtraction of the 123 I SPECT images from the 99m Tc SPECT images were performed. The subtraction SPECT and the coregistered fused SPECT/CT studies were interpreted separately, with images scored on a 5-point scale. Surgical and histopathologic findings were used as the standard of comparison. Results: Surgery was successful in 57 patients (solitary parathyroid adenoma in 48 patients, double parathyroid adenomas in 6 patients, and 10 hyperplastic parathyroid glands in 3 patients). The sensitivities of SPECT (50/70 5 71%) and SPECT/CT (49/70 5 70%) were similar (P 5 0.779). The specificity of SPECT/CT (26/27 5 96%) was significantly greater than that of SPECT (13/27 5 48%; P 5 0.006). The receiver-operating-characteristic area under the curve of SPECT/CT (0.833) was significantly greater than that of SPECT (0.632; P , 0.001). Conclusion: SPECT/CT is significantly more specific than dual-isotope subtraction SPECT for the preoperative identification of parathyroid lesions in patients with primary hyperparathyroidism.

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mentioning

confidence: 99%

Preoperative ¹²³I/^99mTc-Sestamibi Subtraction SPECT and SPECT/CT in Primary Hyperparathyroidism

Neumann¹,

Obuchowski²,

DiFilippo³

2008

J Nucl Med

118

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“…21 Recently, the need for bilateral neck exploration for all patients with PHPT has been questioned in several studies. 22,23 If one can accurately localise an adenoma before surgery, than a directed, minimally invasive approach is potentially feasible. Technetium-99m sestamibi scanning, with a sensitivity and specificity of 90% and 98%, respectively, allows unilateral neck exploration for solitary adenomas, with a failure rate of less than 1%.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of primary hyperparathyroidism – results of a national survey

Özbaş¹,

Pain²,

Tang³

et al. 2003

Annals of the Royal College of Surgeons of England

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“…After the introduction of IOPTH monitoring, the overall cure rate improved to 97%. Although in most cases primary hyperparathyroidism is caused by a single parathyroid adenoma [16][17][18], a few patients have parathyroid hyperplasia or multiple adenomas. An excellent success rate can be achieved by focused parathyroidectomy with IOPTH monitoring.…”

Section: Groupmentioning

confidence: 99%

Minimally invasive surgery for primary hyperparathyroidism with or without intraoperative parathyroid hormone monitoring

et al. 2010

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Bilateral neck exploration, the identification of all parathyroid glands and removal of all abnormal glands, has traditionally been regarded as the standard surgical strategy for the treatment of primary hyperparathyroidism (pHPT) [1][2][3][4]. However, in recent years, several investigators have questioned the routine performance of bilateral neck exploration because the cause of pHPT in most patients is a single parathyroid adenoma and preoperative imaging tests, such as Technetium-99m sestamibi scans and ultrasound examination have enabled precise localization of the affected parathyroid gland with high sensitivity [5][6][7]. Use of intraoperative PTH (IOPTH) measurement or the gamma probe with perioperative sestamibi injection has also contributed to improving results A group who underwent surgery without IOPTH monitoring (Group 1; n=87), and a group who underwent surgery with IOPTH monitoring (Group 2; n=80), in which IOPTH was measured at 5, 10, 15 minutes after excision of the abnormal parathyroid gland. Criterion for evaluation as a cure was a drop in intact PTH level of 50% or more from the preoperative baseline value. The overall cure rate in Group 1 was 93.1%. An enlarged parathyroid gland that was consistent with the results of a preoperative imaging study was found in 84 patients (96.6%). The overall cure rate in Group 2 was 97.5%. In 7 of the patients, there was no drop of 50% or more at any of the 3 points in time measured. Two of these patients were found to have had double adenomas, one on each side, during the initial surgery. Three others were eucalcemic and had normal intact PTH values after surgery, and the remaining 2 patients had persistent disease. Although preoperative localization studies are accurate and essential, IOPTH monitoring improves the cure rate of minimally invasive parathyroidectomy. IOPTH monitoring is a valuable adjunct to achieve adequate intraoperative decision-making, recognizing and resecting additional image-negative hyperfunctioning lesions.

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Surgical management of primary hyperparathyroidism

Cited by 103 publications

References 79 publications

Preoperative ¹²³I/^99mTc-Sestamibi Subtraction SPECT and SPECT/CT in Primary Hyperparathyroidism

Preoperative ¹²³I/^99mTc-Sestamibi Subtraction SPECT and SPECT/CT in Primary Hyperparathyroidism

Surgical management of primary hyperparathyroidism – results of a national survey

Minimally invasive surgery for primary hyperparathyroidism with or without intraoperative parathyroid hormone monitoring

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Surgical management of primary hyperparathyroidism

Cited by 103 publications

References 79 publications

Preoperative 123I/99mTc-Sestamibi Subtraction SPECT and SPECT/CT in Primary Hyperparathyroidism

Preoperative 123I/99mTc-Sestamibi Subtraction SPECT and SPECT/CT in Primary Hyperparathyroidism

Surgical management of primary hyperparathyroidism – results of a national survey

Minimally invasive surgery for primary hyperparathyroidism with or without intraoperative parathyroid hormone monitoring

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Preoperative ¹²³I/^99mTc-Sestamibi Subtraction SPECT and SPECT/CT in Primary Hyperparathyroidism

Preoperative ¹²³I/^99mTc-Sestamibi Subtraction SPECT and SPECT/CT in Primary Hyperparathyroidism