The Role of Surgeon-Performed Office and Preincision Ultrasounds in Localization of Parathyroid Adenomas in Primary Hyperparathyroidism

Choi, Jee‐Hye; Jayaram, Anusha; Bresnahan, Erin; Pletcher, Eric; Steinmetz, David C.; Owen, Randall P.; Inabnet, William B.; Fernández-Ranvier, Gustavo; Taye, Aida

doi:10.1016/j.eprac.2022.03.018

Cited by 3 publications

(4 citation statements)

References 28 publications

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“…The sensitivity decreases down to 0.58 and the specificity increases up to 0.79 when the adenoma weight is considered to be 50 gr, which is the cut-off value reported in previous studies in the literature (20). for double adenoma (27,28). Similarly, our study has demonstrated that there has been no significant difference between the weight of the parathyroid gland calculated by using the three dimensions measured by USG and the pathological weight.…”

Section: Resultssupporting

confidence: 67%

“…The other patient with a substernal parathyroid adenoma did not wish to undergo surgery because of concomitant systemic disease. Of the adenomas, 10.9%(28) were located in the right superior lobe, 33.7% (87) in the right inferior lobe, 10.1%(26) in the left superior lobe, 39.9% (103) in the left inferior lobe, 2.7% (7) were intrathyroidal, and 2.7%(7) were in other locations.…”

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confidence: 98%

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Use of preoperative ultrasonography adenoma size measurements for accurate localization estimation in parathyroid adenomas

KOCAÖZ,

YAZICIOĞLU,

ÇOMÇALI

et al. 2024

Archives of Current Medical Research

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Introduction: Primary hyperparathyroidism (pHPT) is the most common cause of hypercalcemia. PHPT is characterized by high serum calcium and parathormone (PTH) levels. Hyperactivity of one or more parathyroid glands was observed. Materials and Methods: The medical records of 245 patients with pHPT who underwent parathyroidectomy were reviewed retrospectively. Imaging techniques used to confirm the localization of the hyperactive parathyroid gland and factors affecting the success of laboratory methods were investigated. Results: It was found that 7.8% (19) of 245 patients had incorrect localization. With MIBI, 81.2% of adenomas were correctly localized. The weight calculated using preoperative USG measurements was approximately similar to the macroscopic weight (p = 0.651). In the analysis performed on preoperative USG examination results in patients with false localization, the lesion diameter was significantly lower than 12 mm and the calculated weight was significantly lower than 39 g (p = 0.005 and p < 0.001). Conclusion: Preoperative USG largely localizes the location of parathyroid adenomas. However, further examination should be performed in lesions with a parathyroid gland longest diameter of less than 12 mm in USG and a weight of less than 39 g with volume detection. In these patients, intraoperative PTH (IOPTH) should be used to increase the success of the operation.

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Section: Resultssupporting

confidence: 67%

mentioning

confidence: 98%

Use of preoperative ultrasonography adenoma size measurements for accurate localization estimation in parathyroid adenomas

KOCAÖZ,

YAZICIOĞLU,

ÇOMÇALI

et al. 2024

Archives of Current Medical Research

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“…This intra-operatory "before skin incision" localisation procedure might enhance the results of pre-operatory echography, thus allowing a minimally invasive parathyroidectomy. However, the implementation of such a protocol largely depends on each centre standards rather than being a guideline recommendation [60][61][62][63]. Overall, negative or discordant pre-operatory imaging results in PHP do not exclude a successful parathyroidectomy in the hands of a skilled surgeon [44,45].…”

Section: Concordance Of Pre-operatory Localisation Studies In Phpmentioning

confidence: 99%

Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue

Carsote,

Stanciu,

Popa

et al. 2023

Medicina

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Diagnosis of primary hyperparathyroidism (PHP) is based on blood assessments in terms of synchronous high calcium and PTH (parathormone), but further management, particularly parathyroid surgery that provides the disease cure in 95–99% of cases, requires an adequate localisation of the parathyroid tumour/tumours as the originating source, with ultrasound and 99m-Technetium (99m-Tc) sestamibi scintigraphy being the most widely used. We aimed to introduce an adult female case diagnosed with PHP displaying unexpected intra-operatory findings (ectopic thyroid tissue) in relation to concordant pre-operatory imaging modalities (ultrasound + dual-phase 99m-Tc pertechnetate and sestamibi scintigraphy + computed tomography) that indicated bilateral inferior parathyroid tumours. A sudden drop in PTH following the removal of the first tumour was the clue for performing an extemporaneous exam for the second mass that turned out to be non-malignant ectopic thyroid tissue. We overviewed some major aspects starting from this case in point: the potential pitfalls of pre-operatory imaging in PHP; the concordance/discordance of pre-parathyroidectomy localisation modalities; the need of using an additional intra-operatory procedure; and the clues of providing a distinction between pathological parathyroids and thyroid tissue. This was a case of adult PHP, whereas triple localisation methods were used before parathyroidectomy, showing concordant results; however, the second parathyroid adenoma was a false positive image and an ectopic thyroid tissue was confirmed. The pre-operatory index of suspicion was non-existent in this patient. Hybrid imaging modalities are most probably required if both thyroid and parathyroid anomalies are suspected, but, essentially, awareness of the potential pitfalls is mandatory from the endocrine and surgical perspectives. Current gaps in imaging knowledge to guide us in this area are expected to be solved by the significant progress in functional imaging modalities. However, the act of surgery, including the decision of a PTH assay or extemporaneous exam (as seen in our case), represents the key to a successful removal procedure. Moreover, many parathyroid surgeons may currently perform 4-gland exploration routinely, precisely to avoid the shortcomings of preoperative localisation.

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“…Recently, however, there has evolved a paradigm of limited surgical exploration, wherein only the enlarged and hyperfunctioning gland(s) is approached, exposed, and removed. Although both four-gland neck exploration and limited surgical exploration have a valid role in appropriately selected patients, the targeted approach has a comparable cure rate in addition to limiting exploration to one side, hence less perioperative complications [5,6]. The success of a focused approach is determined by preoperative identification of abnormally enlarged or hyperfunctioning parathyroid adenoma.…”

Section: Introductionmentioning

confidence: 99%

Surgeon-Performed Ultrasound in Preoperative Parathyroid Localization: A Real-World Experience in a Community Hospital

Mustapha,

Jake,

Natasha

2024

J Surgical Endocrinol

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The Role of Surgeon-Performed Office and Preincision Ultrasounds in Localization of Parathyroid Adenomas in Primary Hyperparathyroidism

Cited by 3 publications

References 28 publications

Use of preoperative ultrasonography adenoma size measurements for accurate localization estimation in parathyroid adenomas

Use of preoperative ultrasonography adenoma size measurements for accurate localization estimation in parathyroid adenomas

Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue

Surgeon-Performed Ultrasound in Preoperative Parathyroid Localization: A Real-World Experience in a Community Hospital

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