BEST PRACTICE NO 183: Examination of parathyroid gland specimens

Johnson, Sarah J.; Sheffield, E.; McNicol, A. M.

doi:10.1136/jcp.2002.002550

Cited by 34 publications

(26 citation statements)

References 47 publications

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“…The gold standard approach of bilateral neck exploration in the treatment of PHPT is gradually shifting to a more minimally invasive approach (20), (55), (56), (57). Most surgeons believe that a bilateral neck exploration is an over treatment especially in cases were there is a solitary parathyroid adenoma (56).…”

Section: Minimally Invasive Parathyroidectomymentioning

confidence: 99%

“…Most surgeons believe that a bilateral neck exploration is an over treatment especially in cases were there is a solitary parathyroid adenoma (56). Minimally invasive surgery may entail a mini open approach through a 2-3cm unilateral incision, or a videoscopically assisted surgery, or a endoscopic, or a radioguided technique (57). Regardless of the approach of Minimally Invasive Parathyroidectomy, preoperative localization is mandatory assuming the hyperparathyroidism is caused by a solitary parathyroid adenoma (56).…”

Section: Minimally Invasive Parathyroidectomymentioning

confidence: 99%

“…Regardless of the approach of Minimally Invasive Parathyroidectomy, preoperative localization is mandatory assuming the hyperparathyroidism is caused by a solitary parathyroid adenoma (56). However recent studies have shown that using SPECT imaging with other imaging modalities (20), (47), (55), (47), (56), (57) can improve detection for single or multiple adenoma detection.…”

Section: Minimally Invasive Parathyroidectomymentioning

confidence: 99%

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Cervical SPECT Camera for Parathyroid Imaging

None¹

2012

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Section: Minimally Invasive Parathyroidectomymentioning

confidence: 99%

Section: Minimally Invasive Parathyroidectomymentioning

confidence: 99%

Section: Minimally Invasive Parathyroidectomymentioning

confidence: 99%

See 1 more Smart Citation

Cervical SPECT Camera for Parathyroid Imaging

None¹

2012

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“…PHP je kombinacija hiperplazije glavnih i oksifilnih ćelija, u najvećem broju slučajeva nastaje sekundarno zbog hiperplazije glavnih ćelija. Hiperplazija može biti difuzna ili nodularna, kao i primarna, sekundarna ili tercijarna [2][3][4][5][6][7][8][9][10][11].…”

Section: Introductionunclassified

“…Oko 20% primarnih PHP (pPHP) posledica je hiperplazije glavnih ćelija i udružena je sa nekim od naslednih sindroma, od kojih su najvažniji sindromi multiple endokrine neoplazije jedan i dva (MEN 1 i 2). PŽ su izmenjene u 90% slučajeva MEN1, i 30-40% slučajeva MEN2 sindroma [7,9,[12][13][14][15].…”

Section: Introductionunclassified

Subtraction parathyroid scintigraphy with 99mTc - liposolubile radiopharmaceuticals in primary and secondary hyperplasia of parathyroid glands: Correlation with weight and histopathological findings

Dugonjic¹

2014

Tim Med Glas

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Sažetak:Paratireoidnu hiperplaziju (PHP) definišemo kao apsolutno povećanje mase parenhimskih ćelija paratireoidnih žlezda (PŽ). PHP može biti primarna, sekundarna ili tercijarna. Hiperplastično izmenjene paratireoidne žlezde najčešće su asimetrično uvećane, uz postojanje "dominantne" žlezde. Da bi se postavila histološka dijagnoza PHP, potrebno je da budu pregledane najmanje dve PŽ. Suptotalna paratireoidektomija, koja predstavlja kompletno uklanjanje tri hiperplastične žlezde i ostavljanje malog dela četvrte PŽ, je terapija izbora. Postojanje velikog procenta rekurence bolesti nalaže potrebu preoperativnog otkrivanja lokalizacije svih hiperplastično izmenjenih PŽ, dijagnostičkim lokalizacionim metodama visoke osetljivosti. Paratireoidna scintigrafija lokalizuje oko 60% hiperplastično izmenjenih PŽ. Cilj: Cilj ovog rada bio je da utvrdi povezanost pozitivnosti nalaza suptrakcione paratireoidne scintigrafije (SPS) 99mTc -liposolubilnim radiofarmacima, sa težinom i histopatološkim nalazom u patohistološkom supstratu PŽ, kod bolesnika sa primarnom, sekundarnom i tercijarnom hiperplazijom PŽ. Materijal i metode: Kod 27 bolesnika sa primarnom/sekundarnom PHP preoperativno je uraĎena paratireoidna scintigrafija. Petnaest minuta i dva sata od iv. injekcije 740MBq 99mTc -MIBI ili 99mTc-tetrofosmina, ispitaniku u ležećem položaju, raĎene su statička scintigrafija regije glave i vrata i statička scintigrafija regije grudnog koša. Četiri sata (ili po potrebi i više -do 24 sata) od iv. davanja prve injekcije, kada se 99mTc -MIBI/99mTc-tetrofosmin isprazni iz štitaste i paratireoidnih žlezda, davana je iv. injekcija 185MBq Tc99m-pertehnetata i raĎena statička scintigrafija štitaste žlezde. Suptrakcija scintigrama štitaste žlezde od scintigrama PŽ raĎena je posle normalizacije i korekcije scintigrafskih slika zbog pomeranja bolesnika. Scintigrafski nalazi ocenjivani su ocenom od 1 do 5, u zavisnosti od stepena nakupljanja radiofarmaka u PŽ. Scintigrami sa ocenom 3, 4 i 5 uzimani su kao pozitivni nalazi. Makroskopskom obradom odstranjenih PŽ analiziran je broj, veličina i masa žlezda, a u mikroskopskoj obradi intraoperativno ex tempore dijagnostikom i na stalnom preparatu, standardnim hematoksilin-eozin bojenjem, utvrĎivan je supstrat: adenom, hiperplazija, vrsta hiperplazije, distribucija i zastupljenost glavnih, svetlih, oksifilnih ćelija i degenerativne promene. Rezultati: Scintigrafija je lokalizovala dominantnu PŽ kod svih bolesnika, sa osetljivošću izračunatu po bolesniku 100%. Od 73, otkrivena je 51 hiperplastično izmenjena PŽ, sa osetljivošću po broju otkrivenih žlezda 70%. Hiperplastične PŽ težile su od 0,1 do 6, g, (medijana -1g). Značajna pozitivna korelacija naĎena je izmeĎu scintigrafskog nalaza i težine PŽ, (p<0,0001). Četiri bolesnika imalo je difuznu PHP, a 23 bolesnika nodularnu PHP. Nije bilo značajne razlike u scintigrafskom nalazu u odnosu na vrstu hiperplazije. Značajna pozitivna korelacija naĎena je izmeĎu težine PŽ i vrste hiperplazije (p<0,05). Zaključak: Osetljivost suptrakcione paratireoidne scintigr...

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Intraoperative Identification of Thyroid and Parathyroid Tissues During Human Endocrine Surgery Using the MasSpec Pen

DeHoog,

King,

Keating

et al. 2023

JAMA Surg

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ImportanceIntraoperative identification of tissues through gross inspection during thyroid and parathyroid surgery is challenging yet essential for preserving healthy tissue and improving outcomes for patients.ObjectiveTo evaluate the performance and clinical applicability of the MasSpec Pen (MSPen) technology for discriminating thyroid, parathyroid, and lymph node tissues intraoperatively.Design, Setting, and ParticipantsIn this diagnostic/prognostic study, the MSPen was used to analyze 184 fresh-frozen thyroid, parathyroid, and lymph node tissues in the laboratory and translated to the operating room to enable in vivo and ex vivo tissue analysis by endocrine surgeons in 102 patients undergoing thyroidectomy and parathyroidectomy procedures. This diagnostic study was conducted between August 2017 and March 2020. Fresh-frozen tissues were analyzed in a laboratory. Clinical analyses occurred in an operating room at an academic medical center. Of the analyses performed on 184 fresh-frozen tissues, 131 were included based on sufficient signal and postanalysis pathologic diagnosis. From clinical tests, 102 patients undergoing surgery were included. A total of 1015 intraoperative analyses were performed, with 269 analyses subject to statistical classification. Statistical classifiers for discriminating thyroid, parathyroid, and lymph node tissues were generated using training sets comprising both laboratory and intraoperative data and evaluated on an independent test set of intraoperative data. Data were analyzed from July to December 2022.Main Outcomes and MeasuresAccuracy for each tissue type was measured for classification models discriminating thyroid, parathyroid, and lymph node tissues using MSPen data compared to gross analysis and final pathology results.ResultsOf the 102 patients in the intraoperative study, 80 were female (78%) and the median (IQR) age was 52 (42-6) years. For discriminating thyroid and parathyroid tissues, an overall accuracy, defined as agreement with pathology, of 92.4% (95% CI, 87.7-95.4) was achieved using MSPen data, with 82.6% (95% CI, 76.5-87.4) accuracy achieved for the independent test set. For distinguishing thyroid from lymph node and parathyroid from lymph node, overall training set accuracies of 97.5% (95% CI, 92.8-99.1) and 96.1% (95% CI, 91.2-98.3), respectively, were achieved.Conclusions and RelevanceIn this study, the MSPen showed high performance for discriminating thyroid, parathyroid, and lymph node tissues intraoperatively, suggesting this technology may be useful for providing near real-time feedback on tissue type to aid in surgical decision-making.

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BEST PRACTICE NO 183: Examination of parathyroid gland specimens

Cited by 34 publications

References 47 publications

Cervical SPECT Camera for Parathyroid Imaging

Cervical SPECT Camera for Parathyroid Imaging

Subtraction parathyroid scintigraphy with 99mTc - liposolubile radiopharmaceuticals in primary and secondary hyperplasia of parathyroid glands: Correlation with weight and histopathological findings

Intraoperative Identification of Thyroid and Parathyroid Tissues During Human Endocrine Surgery Using the MasSpec Pen

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