US-guided Microwave Ablation of Hyperplastic Parathyroid Glands: Safety and Efficacy in Patients with End-Stage Renal Disease—A Pilot Study

Abstract

Purpose To evaluate the safety and efficacy of microwave ablation (MWA) in patients with end-stage renal disease and secondary hyperparathyroidism. Materials and Methods The study protocol was approved by the human ethics review committee. Between March 1, 2014, and June 30, 2015, 51 patients (25 men, 26 women; mean age ± standard deviation, 53.1 years ± 12.9) were enrolled. All patients had at least one enlarged parathyroid gland and secondary symptomatic hyperparathyroidism, which was treated with ultrasonographically (US) guided MWA. The levels of intact parathyroid hormone, serum calcium, phosphorus, and alkaline phosphatase were compared before and after MWA. Paired-sample t tests and paired-sample Wilcoxon signed-rank tests were used to compare treatment outcomes before and after MWA. Results Complete ablation was achieved in all 96 glands in 51 of 120 patients with severe secondary hyperparathyroidism. The mean follow-up time was 11.1 months ± 3.3. The maximum diameter of the glands ranged from 0.5 cm to 4.8 cm (mean, 1.5 cm ± 0.6). The ablation time for each gland was 216.1 seconds ± 130.1. The mean serum intact parathyroid hormone, calcium, and phosphorus levels after MWA (400 pg/mL [400 ng/L; range, 151.3-629.0 ng/L], 2.33 mmol/L ± 0.23, and 1.54 mmol/L ± 0.43, respectively) were significantly lower than those before MWA (1203 pg/mL [1203 ng/L; range, 854.7-1694.5 ng/L], 2.53 mmol/L ± 0.24, and 1.97 mmol/L ± 0.50, respectively; P < .01), while the alkaline phosphatase levels did not change with MWA (P > .05). Ipsilateral recurrent laryngeal nerve injury was seen in one patient (2%). A hematoma developed during one procedure in one patient (2%) and was treated successfully with injection of thrombin. Conclusion US-guided MWA is safe and effective for destroying parathyroid gland tissue in patients with end-stage renal disease and severe secondary hyperparathyroidism. Further experience with the technique is clearly necessary. RSNA, 2016.

Efficacy of Ultrasound-guided Radiofrequency Ablation of Parathyroid Hyperplasia: Single Session vs. Two-Session for Effect on Hypocalcemia

“…In previous study, Zhou et al demonstrated the feasibility and efficacy of microwave ablation of parathyroid glands and showed that serum PTH and calcium decreased significantly after MWA in patients with SHPT 41 . In current study, we used US-guided RFA to treat parathyroid hyperplasia in 56 patients with SHPT caused by CKD.…”

Risk Factors of Severe Hypocalcemia After US-Guided Percutaneous Microwave Ablation of the Parathyroid Gland in Patients with Secondary Hyperparathyroidism

“…MWA was performed under local anesthesia with 2% lidocaine (Synera, Salt Lake City, UT, USA) at the puncture site. The hydrodissection technique was performed for nerve protection . With US guidance, 40 to 60 mL normal saline (NS) was first injected into the area around the parathyroid nodule to offer heat insulation and nerve isolation.…”

“…Parathyroidectomy (PTX) is necessary for SHPT patients who are refractory to medical therapy . Recently, due to minimal injury, an effective decrease in intact parathyroid hormone (iPTH) and good repeatability, ultrasound (US)‐guided percutaneous microwave ablation (MWA) has been gradually accepted in clinical practice …”

“…Complications from treating SHPT, such as voice changes, hematoma formation, numbness, hypocalcemia, and pain, have been reported . Hypocalcemia is the most common medical complication after both PTX and MWA, which could be severe and prolonged in some situations.…”

Efficacy and safety of microwave ablation for ectopic secondary hyperparathyroidism: a feasibility study

“…Promising results have been reported with the use of microwave ablation (MWA), a minimally invasive ablation technique, to treat incipient and recurrent SHPT nodules [25,26]. The aim of the present study was to determine the CONTACT Ming-An Yu yma301@163.com Interventional Ultrasound Center, China-Japan Friendship Hospital, 2 Yinghua Dong Road, Beijing 100029, China feasibility of MWA in terms of short-term efficacy and safety in chronic renal failure patients with ectopic SHPT.…”