Can localization studies be used to direct focused parathyroid operations?

Arıcı, Cumhur; Cheah, Wei-Keat; Ituarte, Philip H.G.; Morita, Eugene; Lynch, Terry C.; Siperstein, Allan; Duh, Quan Yang; Clark, Orlo H.

doi:10.1067/msy.2001.114556

Cited by 195 publications

(139 citation statements)

References 33 publications

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“…This is comparable to the rates reported after conventional bilateral neck exploration [20]. The parathyroid imaging studies reported 96 % sensitivity and 88 % accuracy [5,6]. The limited accuracy of parathyroid imaging precludes the surgeon from completely depending on the preoperative localisation studies.…”

Section: Discussionsupporting

confidence: 62%

“…Research has shown that the sensitivity of ultrasonography and sestamibi localisation individually are 65 % and 80 %, respectively. Similarly, the sensitivity and accuracy of combined parathyroid imaging are 78-96 % and 88 % [4][5][6]. However, the sensitivity, specificity and accuracy rate of intraoperative parathormone assay (IOPTH) are 97 %, 100 % and 97 %, respectively, which is very high [7].…”

Section: Introductionmentioning

confidence: 99%

“…However, the sensitivity, specificity and accuracy rate of intraoperative parathormone assay (IOPTH) are 97 %, 100 % and 97 %, respectively, which is very high [7]. Also, in a substantial number of patients, no definitive localisation was made, as preoperative localisation studies were concordant only 50-60 % of the time [1,5,8]. But in 13-19 % of patients, monitoring the IOPTH levels during parathyroidectomy directly aids the surgeon's operative approach [7,9].…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of Rapid Parathormone Assay for Enabling Minimally Invasive Parathyroid Excision

2012

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There is no doubt that the success of minimally invasive parathyroidectomy (MIP) has changed the whole treatment of patients with primary hyperparathyroidism, especially the approach towards traditional bilateral neck exploration. A single adenoma is the most common cause of primary hyperparathyroidism and its removal results in cure. Hence, it is worth the effort to localise and excise the single adenoma using modern technologies such as highquality sestamibi scans and to confirm complete excision using rapid intra operative parathormone (IOPTH) assays. The objective of the study was to evaluate the feasibility of rapid IOPTH assay in successfully facilitating minimally invasive parathyroid excision. This research involved the retrospective study of seven patients, who underwent MIP at Sagar Hospital in Bengaluru, India, for parathyroid adenoma. All patients with evidence of unifocal disease on sestamibi scanning and cervical ultrasonography, underwent MIP via 2-3 cm lateral incision. Blood samples for measurement of IOPTH were taken at the time of induction of anaesthesia and 10 min after the adenoma excision. Reduction of parathormone (PTH) levels of more than 50 % in the postexcision sample was taken as evidence for complete extirpation of parathyroid adenoma. A solitary adenoma was identified in all the seven patients. After MIP, IOPTH levels fell in six of the seven patients.Following the surgery, all the cases were followed up for a period of 1 month. During this time, except for one patient, six patients remained asymptomatic and blood tests revealed normal serum calcium levels. A histopathological examination confirmed the diagnosis of parathyroid adenoma in six of the seven patients. After accurate preoperative localisation of the adenoma in patients with primary hyperparathyroidism, MIP with IOPTH measurement offers a safe and successful outcome.

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Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility of Rapid Parathormone Assay for Enabling Minimally Invasive Parathyroid Excision

2012

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“…Many authors have reported on MIBIscintigraphy in combination with neck ultrasonography [24][25][26][27][28]. Ultrasonography has the advantage of being a readily available, cheap, preoperative localization study without the use of radiation, but it is strongly operator depended and the resulting image is difficult to interpret by the operating surgeon.…”

Section: Discussionmentioning

confidence: 99%

Additional Imaging Following a Negative Sestamibi Scan in Primary Hyperparathyroidism

Twigt¹,

Vollebregt²,

Hooge³

et al. 2012

IJOHNS

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Background: The objective of this study was to assess the additional yield of US and CT following a "negative" initial MIBI-scintigraphy (MIBI) in patients with primary hyperparathyroidism. Methods: Prospective data were collected regarding 100 consecutive patients, preferentially undergoing a minimally invasive parathyroidectomy (MIP). MIBI was the initial imaging study for localizing a solitary adenoma, followed by US and CT (US/CT) in "MIBI-negative"-patients. Results: Surgery led to normocalcemia in 98 patients (98%) after one operation. Overall 97 patients had solitary parathyroid disease while three patients had multiglandular disease. The sensitivity of imaging increased from 74% for MIBI alone to 92% following subsequent US/CT in "MIBI-negative"-patients. The positive predictive value of a "positive" MIBI was 96% and 76% of a positive US/CT following negative MIBI. The proportion of patients who underwent successful MIP increased from 60 to 72%. Conclusions: MIBI and the combination of US and CT are complementary imaging studies. Additional localization studies after a negative sestamibi scan enhances the number of patients with primary hyperparathyroidism profiting from a minimally invasive approach.

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“…Since the first report (Coakley et al, 1989), it has been shown that MIBI scintigraphy is useful for localization of enlarged parathyroid glands. However, the sensitivity and PPV for MIBI were unsatisfactory in the patients with concomitant thyroid disease, due to confusion from enlarged thyroid glands or nodules (Arici et al, 2001). Apart from parathyroid localization studies, an exact thyroid work-up with confirmation of number and localization of all thyroid nodules is necessary preoperatively in the endemic goiter region.…”

Section: Authorsmentioning

confidence: 99%

Preoperative localization and minimally invasive management of primary hyperparathyroidism concomitant with thyroid disease

Zheng

Wang

et al. 2007

J. Zhejiang Univ. - Sci. B

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Abstract:The coexistence of thyroid diseases with primary hyperparathyroidism (PHPT) can present a challenge in the clinical diagnosis and management for these patients. This study aims to determine the frequency of coexisting thyroid gland lesions in a consecutive series patients with PHPT, and to analyze the clinical features, diagnosis and treatment of these patients. Twenty-two cases of a total of 52 PHPT patients who had synchronous thyroid and parathyroid pathology were surgically managed in this study. Thirteen patients had ipsilateral thyroid nodules, and 9 patients had thyroid nodules in contralateral or bilateral side. Seven patients underwent direct parathyroidectomy and hemithyroidectomy via a mini-incision (about 3 cm), while other 15 procedures were converted to Kocher incision. Seventeen nodular goiter (32.7%), 2 thyroiditis (3.8%), 2 thyroid adenoma (3.8%) and 1 thyroid carcinoma (1.9%) coexisting with parathyroid adenoma were pathologically diagnosed. The sensitivity of preoperative ultrasonography (US) and methoxy-isobutyl-isonitrile (MIBI) scintigraphy for parathyroid lesions was 63.6% and 85.7%; and the overall positive predictive values for MIBI and US were 100% and 95.5% respectively. A high incidence of thyroid diseases that coexisted with PHPT in literatures was briefly reviewed. Our study illustrated the need for clinical awareness of concomitant PHPT and thyroid disease. A combination of US, computed tomography (CT) and MIBI scintigraphy would be recommended for preoperative localization of enlarged parathyroid adenoma and for evaluation of thyroid lesions. Synchronous treatment of associated thyroid abnormalities is desirable, and open minimally invasive surgical approach with additional resection of isolated ipsilateral thyroid nodules is possible in some of these patients.

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Can localization studies be used to direct focused parathyroid operations?

Cited by 195 publications

References 33 publications

Feasibility of Rapid Parathormone Assay for Enabling Minimally Invasive Parathyroid Excision

Feasibility of Rapid Parathormone Assay for Enabling Minimally Invasive Parathyroid Excision

Additional Imaging Following a Negative Sestamibi Scan in Primary Hyperparathyroidism

Preoperative localization and minimally invasive management of primary hyperparathyroidism concomitant with thyroid disease

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