The Main Surgical Principles and Techniques In the Management of Primary Hyperparathyroidism

Uludağ, Mehmet; Aygün, Nurcihan; İşgör, Adnan

doi:10.14744/semb.2019.67944

Cited by 18 publications

(53 citation statements)

References 64 publications

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“…Our preoperative 99m Tc-MIBI imaging showed that the degree of visualization of the superior PGs was lower, consistent with previous research (33). This may be due to the effect of hemodynamics, gravity, and a relatively narrow growth area, leading to slower pathological growth in the superior PGs than in the inferior PGs (32). From this perspective, we could select the superior PGs for preservation if a dilemma in selecting PG arises intraoperatively.…”

Section: Discussionsupporting

confidence: 88%

“…During the embryonic development of PGs, inferior PGs originate from the third pharyngeal pouches, while the superior PGs originate from the fourth pharyngeal pouch. Therefore, the anatomical origins of the superior and inferior PGs differ (31,32), which drew our attention to the difference between the superior and inferior PGs. We found that the superior PGs tended to have a lighter weight, smaller volume, lower PCNA expression, and lower degree of hyperplasia.…”

Section: Discussionmentioning

confidence: 99%

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Use of 99mTc-sestamibi SPECT/CT imaging in predicting the degree of pathological hyperplasia of the parathyroid gland: semi-quantitative analysis

Yang

Chen

et al. 2021

Quant Imaging Med Surg

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Background: Previous studies have demonstrated that 99m Tc-sestamibi ( 99m Tc-MIBI) Single-Photon Emission Computed Tomography/ Computed Tomography (SPECT/CT) imaging is an effective isotopic technique for locating the parathyroid in secondary hyperparathyroidism (SHPT). This study aimed to explore further the correlation between 99m Tc-MIBI SPECT/CT imaging and SHPT to demonstrate the value of 99m Tc-MIBI SPECT/CT in evaluating the degree of pathological hyperplasia of the parathyroid gland (PG). Methods:The demographics, surgical records, and follow-up information of 91 patients were recorded and analyzed. A total of 216 paraffin-embedded PGs of 54 patients were obtained and analyzed.Results: Patients with 99m Tc-MIBI negative PG(s) had significantly lower preoperative serum phosphorus and higher serum calcium levels at 6 months postoperatively compared to those with 99m Tc-MIBI positive PG(s) (P<0.05). We also found a higher total uptake ratio of the region of interest (URRI) and higher URRI max in the hypocalcemia group than in the non-hypocalcemia group. Both URRI total (P=0.003) and URRI max (P=0.028) were independent risk factors for hypocalcemia 6 months postoperatively. The URRI values of the PGs were significantly positively correlated with glandular weight (R 2 =0.343, P<0.001), glandular volume (R 2 =0.240, P<0.001), and degree of pathological hyperplasia (P<0.001). However, the URRI value of the PGs exhibited a notably weak correlation with proliferating cell nuclear antigen (PCNA) (R 2 =0.035, P=0.006). The area under the receiver operating characteristic curve showed a URRI evaluative value of 0.771 for diffuse and nodular types in 216 PGs (P<0.001). We further evaluated 167 nodular-type PGs, distinguishing between nodular hyperplasia and a single nodule; the URRI evaluative value reached 0.819, which was higher than the volume or weight (P<0.001).Conclusions: The 99m Tc-MIBI SPECT/CT scintigraphy results were related to serum calcium levels at 6 months after total parathyroidectomy with autotransplantation (TPTX+AT), suggesting the occurrence of hypocalcemia (6 months after TPTX+AT). More importantly, this technique effectively evaluated the pathological hyperplasia of PGs preoperatively, and therefore, could assist surgeons in selecting the PGs with the lowest degree of hyperplasia intraoperatively.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Use of 99mTc-sestamibi SPECT/CT imaging in predicting the degree of pathological hyperplasia of the parathyroid gland: semi-quantitative analysis

Yang

Chen

et al. 2021

Quant Imaging Med Surg

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“…Most cases involved a single abnormal parathyroid gland located in an usual neck site, but many of such changes occur in other sites including the thymus gland, the retroesophageal space or the thyroid gland. Sometimes, parathyroid lesions have been reported in the pericardium or soft and adipose tissues of the mediastinum up to the angle of the jaw [3,4]. The differentiation between hyperplasia and adenoma may not be easy even for an experienced surgeon.…”

Section: Introductionmentioning

confidence: 99%

Surgical Management of Primary Hyperparathyroidism—Clinicopathologic Study of 1019 Cases from a Single Institution

Gawrychowski

Kowalski

Buła

et al. 2020

JCM

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Background: Primary hyperparathyroidism (pHPT) is an endocrine disorder characterized by hypercalcemia and caused by the presence of disordered parathyroid glands. Parathyroidectomy is the only curative therapy for pHPT, but despite its high cure rate of 95–98%, there are still cases where hypercalcemia persists after this surgical procedure. The aim of this study was to present the results of a surgical treatment of patients due to primary hyperparathyroidism and failures related to the thoracic location of the affected glands. Methods: We present a retrospective analysis of 1019 patients who underwent parathyroidectomy in our department in the period 1983–2018. Results: Among the group of 1019 operated-on patients, treatment failed in 19 cases (1.9%). In 16 (84.2%) of them, the repeated operation was successful. In total, 1016 patients returned to normocalcemia. Conclusions: Our results confirm that parathyreoidectomy is the treatment of choice for patients with primary hyperparathyroidism. The ectopic position of the parathyroid gland in the mediastinum is associated with an increased risk of surgical failure. Most parathyroid lesions in the mediastinum can be safely removed from the cervical access.

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“…Failure to detect adenoma with conventional preoperative studies, may result in unsuccessful surgery requiring reoperation, prolonged hypercalcemia, and possible future complications. [ 14 ] For this reason, in selected cases, we use ASVS with the approval of the MEB in order to eliminate the need for a second operation in patients with adenomas whose localization cannot be determined. Although ASVS is an invasive technique, prolonged hypercalcemia, patient stress, and additional costs due to complications of a possible reoperation can be prevented with the meticulous use of ASVS.…”

Section: Discussionmentioning

confidence: 99%

“…In this way, the quantity of complex cases increases and the effectiveness of disease management improve. [ 14 , 15 ]…”

Section: Introductionmentioning

confidence: 99%

Clinical adaptation of auxiliary methods and multidisciplinary approach to changing trends in parathyroid surgery

et al. 2021

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To examine the effects of multidisciplinary approach and adjunct methods, on the surgical strategy, complications and treatment success of parathyroid surgery. Patients, who were operated for primary hyperparathyroidism (n = 411) at our institution between 2012 and 2019 were reviewed retrospectively. Preoperative imaging studies, surgical method, additional diagnostic methods used during surgery, frozen section results, and histopathology findings, complications, persistence, and recurrence were examined. Localization was determined by first-line examinations in 79.9% (n = 348). Four-dimensional computed tomography was used with an 83.3% success rate. Lateralization success for angiographic selective venous sampling was 80.3% and exact localization success was 65.1%. Bilateral neck exploration was performed in 10.6% (n = 37) of the patients, and in the remaining 89.4% (n = 311), minimally invasive parathyroidectomy (MIP) was performed. While the complication rate was higher in the bilateral neck exploration group ( P = .019), persistence and recurrence rates were similar between 2 groups. During the study period, annual case volume increased from 9 cases to 103 cases ( P < .001) and the rate of MIP increased from 44.4% to 92.8% over the years ( P < .001). Effective use of adjunct techniques has increased the rates of MIP. The multidisciplinary approach has also provided low complication rates with the increasing number of cases.

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The Main Surgical Principles and Techniques In the Management of Primary Hyperparathyroidism

Cited by 18 publications

References 64 publications

Use of 99mTc-sestamibi SPECT/CT imaging in predicting the degree of pathological hyperplasia of the parathyroid gland: semi-quantitative analysis

Use of 99mTc-sestamibi SPECT/CT imaging in predicting the degree of pathological hyperplasia of the parathyroid gland: semi-quantitative analysis

Surgical Management of Primary Hyperparathyroidism—Clinicopathologic Study of 1019 Cases from a Single Institution

Clinical adaptation of auxiliary methods and multidisciplinary approach to changing trends in parathyroid surgery

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