Technetium-99m sestamibi scintigraphy, magnetic resonance imaging and venous blood sampling in persistent and recurrent hyperparathyroidism.

Fayet, P; Hoeffel, C; Fulla, Y.; Legmann, P.; Hazebroucq, V.; Luton, J P; Chapuis, Y; Richard, Bruno; Bonnin, A

doi:10.1259/bjr.70.833.9227226

Cited by 47 publications

(23 citation statements)

References 20 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%

“…An SVS for PTH was deemed to be positive when a gradient of O50% was found between PTH concentrations at a specific anatomical site of sample collection compared with peripheral blood samples obtained at the time of procedure (17,21).…”

Section: Parathyroid Svs Techniquementioning

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%

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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: Parathyroid Svs Techniquementioning

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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“…Positive venous catheterization, with a technique having low morbidity and high sensitivity (11,66), was consistent with parathyroid tissue. CT and catheterization allowed us to exclude false-positive scintigraphy.…”

Section: Discussionmentioning

confidence: 83%

Video-assisted thoracoscopic surgery as a first-line treatment for mediastinal parathyroid adenomas: strategic value of imaging

Amar

Guignat²,

Tissier³

et al. 2004

European Journal of Endocrinology

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Objective: To present first-line thoracic surgery made possible by localization studies in three patients with ectopic parathyroid adenomas. Design and methods: Three patients with ectopic parathyroid tissue in the mediastinum were examined by ultrasound, technetium-99m sestamibi scintigraphy, computed tomography (CT), and venous catheterization with measurement of parathyroid hormone. Without previous cervical exploration, video-assisted thoracic surgery (VATS) was used in all cases to avoid the need for thoracic open surgical procedures. Results and conclusions: The mediastinal parathyroid glands were all detected at scintigraphy, and CT and venous catheterization were helpful in anatomic and functioning characterization. All pathologic glands were successfully resected, with only one minor complication. VATS can safely remove a deep mediastinal parathyroid adenoma and avoid more aggressive open approaches. In an experienced referral center, systematic and sophisticated imaging studies may accurately identify and localize rare ectopic parathyroid adenomas, and avoid cervical surgery.

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Reoperative Parathyroid Surgery in the Era of Sestamibi Scanning and Intraoperative Parathyroid Hormone Monitoring

Thompson¹

1999

Arch Surg

124

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Hypothesis: Results of reoperative parathyroid surgery (RPS) have improved with the advent of sestamibi parathyroid subtraction scanning and intraoperative parathyroid hormone (IOPTH) monitoring. Design: Retrospective review of patient histories, preoperative localization studies, operative data, including IOPTH monitoring, and outcomes for patients undergoing recent RPS at a single institution. Follow-up was complete (mean, 20 months). Setting: Tertiary care referral center. Patients: All patients undergoing RPS for benign persistent or recurrent primary hyperparathyroidism during the period 1989 to 1997. Main Outcome Measures: Overall cure rate and operative morbidity from RPS; sensitivity and accuracy of preoperative localization studies; and prediction of cure from IOPTH monitoring. Results: The study group included 124 patients (87 women and 37 men). Hypercalcemia was corrected in 109 patients (88%). Permanent recurrent laryngeal nerve in

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Technetium-99m sestamibi scintigraphy, magnetic resonance imaging and venous blood sampling in persistent and recurrent hyperparathyroidism.

Cited by 47 publications

References 20 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

Video-assisted thoracoscopic surgery as a first-line treatment for mediastinal parathyroid adenomas: strategic value of imaging

Reoperative Parathyroid Surgery in the Era of Sestamibi Scanning and Intraoperative Parathyroid Hormone Monitoring

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