Análisis de falsos negativos en la cintigrafía SPECT de paratiroides con sestamibi en pacientes con hiperparatiroidismo primario sometidos a cirugía entre 2008-2015 en hospital universitario

Paillahueque, Gabriela; Massardo, Teresa; Barberán, Marcela; Ocares, Gerson; Gallegos, Iván; Toro, Luis; Araya, A. Verónica

doi:10.4067/s0034-98872017000801021

Cited by 7 publications

(2 citation statements)

References 23 publications

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“…In this regard our findings are in agreement with previous studies. In a study performed on 121 patients, pathophysiological analysis showed adenoma in 3 cases, hyperplasia in 3 cases, and cancer in 1 ( 13 ). Other study described malignancy in 7 patients (6.8%) (14).…”

Section: Discussionmentioning

confidence: 99%

Hyperparathyroidism: Pathological Diagnosis and Association with Parathyroid Localization

Ramaš¹,

Umihanić²,

Kasumović³

et al. 2023

Mater Sociomed

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Background: The most common patohistological finding in primary hyperparathyroidism is adenoma of the parathyroid gland, followed by hyperplasia and the rarest is carcinoma. However, hyperplasia of the parathyroid glands (PTG) is most commonly found in secondary and tertiary hyperparathyroidism. Objective: The aim of this study was to determine the relationship between the localization of the parathyroid glands and pathological diagnosis, as well as the prevalence of individual pathological diagnosis after surgery in patients with hyperparathyroidism. Methods: Analysis of retrospective-prospective database of 79 patients who underwent parathyreoidectomy for hyperparathyroidism in the 7-year study period. Diagnostic methods were used to identify enlarged parathyroid glands as well as to determine their localization: ultrasound examination, scintigraphy and operative finding. Standard hematoxylin eosin staining was used for pathophysiological diagnosis. A correlation analysis between parathyroid gland localization and pathophysiological diagnosis was performed. Results: The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. In the total number of surgically removed parathyroid glands (182), the most common pathophysiological diagnosis was hyperplasia. Parathyroid adenoma was found in 21 cases. Other diagnoses (thyroid nodule / tissue, lymph node, thymus, cancer) were found in 11 cases, while a normal finding was found in 12 glands. Pathophysiological diagnosis of hyperplasia and adenoma were more common in the lower parathyroid glands. Using the chi-square test, no association was found between pathophysiological diagnosis and localization of enlarged parathyroid glands. Conclusion: The most common pathophysiological diagnosis in hyperparathyroidism was hyperplasia and was most commonly found in the inferior parathyroid glands. Adenoma as pathophysiological diagnosis is also most commonly found in the lower parathyroid glands, but without statistical significance.

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Section: Discussionmentioning

confidence: 99%

Hyperparathyroidism: Pathological Diagnosis and Association with Parathyroid Localization

Ramaš¹,

Umihanić²,

Kasumović³

et al. 2023

Mater Sociomed

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“…On the other hand, with concern to parathyroid tumours, pre-operatory false negative results involve between 5.7 and 25% of the patients who perform 99m-Tc sestamibi SPECT scintigraphy, and they are related to the limits of resolution of the technique or a prolonged time from scintigraphy to surgery [69,70]. Also, in patients with large goitres, there is a higher rate of false negative results at ultrasound and 99m-Tc sestamibi scintigraphy [71].…”

Section: Ectopic Thyroid Tissuementioning

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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Is there a consensus between clinical practice guidelines for conventional and molecular nuclear medicine studies in parathyroid pathology?

Hernández

Orduz²,

Ramos

et al. 2021

Ann Nucl Med

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Hyperparathyroidism is a common calcium metabolic disorder, characterized by the presence of high concentrations or inappropriately normal concentrations of parathyroid hormone (PTH) in the context of high calcium. Pharmacological and surgical management is available as treatment. The objective of diagnostic imaging is to determine the location of the causal lesion. For these purposes, non-invasive methods can be divided into anatomical or functional studies, with nuclear medicine studies being in the latter category. The objective of this review, is to establish the similarities and differences that exist in the clinical practice guidelines on conventional and molecular nuclear medicine studies in parathyroid disease.

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Análisis de falsos negativos en la cintigrafía SPECT de paratiroides con sestamibi en pacientes con hiperparatiroidismo primario sometidos a cirugía entre 2008-2015 en hospital universitario

Cited by 7 publications

References 23 publications

Hyperparathyroidism: Pathological Diagnosis and Association with Parathyroid Localization

Hyperparathyroidism: Pathological Diagnosis and Association with Parathyroid Localization

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

Is there a consensus between clinical practice guidelines for conventional and molecular nuclear medicine studies in parathyroid pathology?

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