Are preoperative sestamibi scans useful for identifying ectopic parathyroid glands in patients with expected multigland parathyroid disease?

Karipineni, Farah; Sahli, Zeyad T.; Somervell, Helina; Mathur, Aarti; Prescott, Jason D.; Tufano, Ralph P.; Zeiger, Martha A.

doi:10.1016/j.surg.2017.07.035

Cited by 30 publications

(18 citation statements)

References 9 publications

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“…Different techniques have been proposed to aid in parathyroid gland identification. [9][10][11] Paras and colleagues 12 examined the use of autofluorescence with the Raman technique to differentiate parathyroid glands from other tissues and identified a statistically higher number of parathyroid glands when nearinfrared light (NIRL) was used relative to standard white light (WL). [13][14][15] Variables like patient sex, age, and primary diagnosis exerted no influence on the fluorescent intensity of surrounding tissues, including thyroid.…”

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confidence: 99%

Randomized Controlled Trial Comparing White Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification During Total Thyroidectomy

Dip

Falcó

Verna

et al. 2019

Journal of the American College of Surgeons

124

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BACKGROUND: Parathyroid glands are difficult to identify during total thyroidectomies, and accidental resection can lead to problematic postoperative hypocalcemia. Our main goals were to evaluate the effectiveness of using near-infrared light (NIRL) autofluorescence intraoperatively for parathyroid gland identification and to measure its impact on postoperative hypocalcemia incidence. STUDY DESIGN: Total thyroidectomies were performed on 170 patients with different thyroid pathologies, block-randomized (1:1) into 2 equal groups. Among controls, traditional overhead white light (WL) was used throughout. In the experimental group, NIRL was used to enhance parathyroid gland recognition before thyroid dissection. The number of parathyroid glands identified was compared after thyroid dissection in controls using WL vs pre-dissection in the experimental using NIRL and with WL vs NIRL before thyroid dissection in the experimental group. Postoperative serum calcium levels and hypocalcemia rates were compared. RESULTS: The mean number of parathyroid glands identified pre-dissection with NIRL was the same identified post-dissection with WL (3.5 vs 3.6). In the experimental group, converting from WL to NIRL increased the number of glands detected from 2.6 to 3.5 (p < 0.001), and revealed at least 1 previously missed gland in 67.1% of patients. Calcium levels 7.5 mg/dL were one-tenth as common in the NIRL group (p ¼ 0.005). The adjusted odds of hypocalcemia developing increased by 15% for every 5-g increase in thyroid gland weight (odds ratio 1.15; 95% CI 1.06 to 1.25). All hypocalcemia resolved within 6 months. CONCLUSIONS: Using NIRL during thyroidectomy increases intraoperative identification of parathyroid glands, enhances their detection before thyroid dissection, and decreases the incidence of postoperative hypocalcemia.

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confidence: 99%

Randomized Controlled Trial Comparing White Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification During Total Thyroidectomy

Dip

Falcó

Verna

et al. 2019

Journal of the American College of Surgeons

124

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“…Karipineni failed to provide THPT specific data, as their population also included SHPT, iodine induced HPT, and MEN syndrome induced HPT patients. 16 Overall, they demonstrated sensitivity, for ectopic glands only, of 36% for MIBI and 7% for US.…”

Section: Discussionmentioning

confidence: 93%

“…The authors of these studies defined false positives as an area of distinct MIBI accumulation in an area which did not coincide with an abnormal gland at time of surgery; false negatives were defined as a lack of MIBI accumulation in an area where an abnormal gland was found at time of surgery. 3,16 The authors of this paper decided not to summarise results of this study as sensitivity or specificity as it produced ordinal, not dichotomous, outcomes (fully successful, partially successful and unsuccessful). Therefore, to calculate sensitivity and specificity, it would mean moving the 'partial success' into one of the other groups, creating dichotomous variables.…”

Section: Discussionmentioning

confidence: 99%

Renal failure parathyroidectomy – Is pre-operative imaging worthwhile?

et al. 2019

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“…The combination of US with 99mTc-sestamibi SPECT/CT had a higher sensitivity than US or 99mTcsestamibi SPECT/CT alone (Yuan et al 2016). Most authors thus conclude that ultrasound and sestamibi scintigraphy offer little benefit in localizing ectopic glands and rarely change the conduct of a standard four-gland exploration (Alkhalili et al 2015, Karipineni et al 2018, van der Plas et al 2019. However, some authors have found that SPECT-CT offered useful information (Taieb et al 2013).…”

Section: Preoperative Localizationmentioning

confidence: 99%

The treatment of renal hyperparathyroidism

Almquist

Isaksson

Clyne

2020

Endocrine-Related Cancer

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Renal hyperparathyroidism (rHPT) is a complex and challenging disorder. It develops early in the course of renal failure and is associated with increased risks of fractures, cardiovascular disease and death. It is treated medically, but when medical therapy cannot control the hyperparathyroidism, surgical parathyroidectomy is an option. In this review, we summarize the pathophysiology, diagnosis, and medical treatment; we describe the effects of renal transplantation; and discuss the indications and strategies in parathyroidectomy for rHPT. Renal hyperparathyroidism develops early in renal failure, mainly as a consequence of lower levels of vitamin D, hypocalcemia, diminished excretion of phosphate and inability to activate vitamin D. Treatment consists of supplying vitamin D and reducing phosphate intake. In later stages calcimimetics might be added. RHPT refractory to medical treatment can be managed surgically with parathyroidectomy. Risks of surgery are small but not negligible. Parathyroidectomy should likely not be too radical, especially if the patient is a candidate for future renal transplantation. Subtotal or total parathyroidectomy with autotransplantation are recognized surgical options. Renal transplantation improves rHPT but does not cure it.

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Are preoperative sestamibi scans useful for identifying ectopic parathyroid glands in patients with expected multigland parathyroid disease?

Cited by 30 publications

References 9 publications

Randomized Controlled Trial Comparing White Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification During Total Thyroidectomy

Randomized Controlled Trial Comparing White Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification During Total Thyroidectomy

Renal failure parathyroidectomy – Is pre-operative imaging worthwhile?

The treatment of renal hyperparathyroidism

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