Correlation of parathyroid scanning and anatomy in 261 unselected patients with sporadic primary hyperparathyroidism

Pattou, François; Torres, Gabriel; Mondragón-Sánchez, Alejandro; Huglo, D.; Nguyen, Hieu; Carnaille, B.; Proye, C

doi:10.1067/msy.2099.101579

Cited by 43 publications

(21 citation statements)

References 12 publications

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“…In patients with hyperplastic parathyroid glands sensitivity of preoperative localization procedures ranges between 41 and 62%, but the frequency of multiglandular disease is less than 15% (Malhotra et al 1996, Molinari et al 1996, Blanco et al 1998, Pattou et al 1999. It has also been suggested that MPS imaging can help to distinguish preoperatively hyperplasia from adenomatous disease (Johnston et al 1996).…”

Section: Discussionmentioning

confidence: 99%

“…Selective venous sampling is of little usefulness in the noninvasive era and should be abandoned because of its low sensitivity (41-65%) and positive predictive value, longer technical performing and high cost, and might be useful only in selected patients with persistent or recurrent hyperparathyroidism (Doppman et al 1998, Pattou et al 1999. Magnetic resonance imaging sensitivity does not seem to be different from other techniques, ranging between 77 and 84% (Lee et al 1996, McDermott et al 1996.…”

Section: Discussionmentioning

confidence: 99%

“…Most patients in whom the diagnosis of primary hyperparathyroidism is made require surgical treatment and bilateral neck exploration has represented for many years the standard procedure to perform parathyroidectomy. However, since 85-90% of primary hyperparathyroidism is caused by solitary parathyroid tumours, unilateral exploration and minimally invasive parathyroidectomy, both endoscopic and radioguided, may be currently performed (Borley et al 1996, Bonjer et al 1997a, Norman & Chheda 1997, Naitoh et al 1998, van Vroonhoven & van Dalen 1998, Inabnet et al 1999, Miccoli et al 1999, Pattou et al 1999. In this setting, the interest for preoperative localization procedures is growing and consequently sensitivity and accuracy of noninvasive techniques have improved, but at present it has not been clearly established which procedure should be preferred when parathyroid gland imaging is required.…”

Section: Introductionmentioning

confidence: 99%

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Localization of parathyroid tumours in the minimally invasive era: which technique should be chosen? Population-based analysis of 253 patients undergoing parathyroidectomy and factors affecting parathyroid gland detection.

Lumachi¹,

Ermani²,

Basso³

et al. 2001

Endocrine-Related Cancer

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A series of 253 consecutive patients with proved primary hyperparathyroidism due to parathyroid tumours was reviewed. There were 68 (26.9%) men and 185 (73.1%) women, with a median age of 57 years (range 13-82 years). All patients, prior to successful parathyroidectomy, underwent one or more preoperative localization procedures such as: neck ultrasonography (US) in 191 (75.5%), 201 Tl/ 99m Tc-pertechnetate subtraction scintigraphy (TPS) in 144 (56.9%), CT scan in 92 (36.4%), 99m Tc-sestamibi/ 99m Tc-pertechnetate subtraction scintigraphy (MPS) in 90 (35.6%), selective venous sampling (SVS) with parathyroid hormone (PTH) assay in 30 (11.9%), and magnetic resonance imaging (MRI) in 6 (2.4%) patients. The results were compared with operative and histological findings that showed 235 (92.9%) solitary parathyroid adenomas, 13 (5.1%) carcinomas and 5 (2.0%) double adenomas. Sensitivity and positive predictive value were 82.9% and 93.8% for US, 83.6% and 91.8% for TPS, 81.3% and 98.7% for CT scan, 85.1% and 96.1% for MPS, 65.4% and 80.9% for SVS, and 80.0% and 80.0% for MRI respectively. No different results (P = NS) were found using US, TPS, MPS or CT scan, whereas SVS and MRI sensitivity was lower (P < 0.05). The combination of MPS and US was 94.0% sensitive (P < 0.05) but when TPS, CT scan or MRI were also used overall sensitivity did not improve significantly (P = NS). In conclusion, MPS should be used as the starting preoperative localization procedure, while US and MPS together represent the most reliable noninvasive localization tool. If MPS and US are negative or not in agreement, further studies are not cost-effective and the patient should undergo bilateral neck exploration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Localization of parathyroid tumours in the minimally invasive era: which technique should be chosen? Population-based analysis of 253 patients undergoing parathyroidectomy and factors affecting parathyroid gland detection.

Lumachi¹,

Ermani²,

Basso³

et al. 2001

Endocrine-Related Cancer

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“…Today, focal approach to parathyroidectomy is possible by preoperative imaging studies [26,28,29] using high-resolution ultrasonography, [ 99m Tc]sestamibi scanning, and IOPTH [30,31]. For a focused approach, accurate preoperative localization studies of the diseased parathyroid gland are necessary.…”

Section: Author Contributionsmentioning

confidence: 99%

One hundred double adenomas in primary hyperparathyroidism

et al. 2013

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One hundred double adenomas in primary hyperparathyroidism 295 1 3 SummaryBackground Double adenomas (DAs) occur in 2-15 % of primary hyperparathyroidism (pHPT) patients. To date, the existence of this distinct entity remains controversial. The aim of this study was to evaluate the clinical characteristics and anatomic distribution of DAs to identify anatomic patterns and implications for surgical management.Methods We reviewed prospective database records of 1,464 unselected, consecutive patients who were treated for pHPT in our institution between 1986 and 2012. We identified 100 DA patients (6.8 %) and compared their clinical characteristics with those of solitary adenomas (SAs; n = 1,226) and hyperplasia (including multiple endocrine neoplasia; n = 101).Results A total of 74 % of our patient collective was female. DAs were predominantly located on the right side (30 %) or crossed (23 %) and demonstrated an increased incidence of atypical position (38 %). Patients with DA showed significantly more neuropsychiatric disorders and pancreatitis compared with those in the other groups. Our results revealed higher parathyroid hormone levels in patients with DA compared with those with SA or hyperplasia. In 74 patients, the DA was primarily found, whereas 26 patients needed reoperation. Only nine DAs had developed metachronously. The overall cure rate of all patients with pHPT was 96.4 % (carcinomas excluded).Conclusions DAs are a distinct entity and show no specific characteristic features that could facilitate easy detection. The chance of a metachronous appearance is statistically low, but has significant clinical impact as a major cause for late recurrence of hyperparathyroidism and need for reoperation.Keywords Double adenoma · Primary hyperparathyroidism · Hyperplasia · Hypercalcemia Abbreviations DA double adenoma IOPTH intraoperative parathyroid hormone assay MEN multiple endocrine neoplasia PTH parathyroid hormone pHPT primary hyperparathyroidism SA single adenomaThe first two authors contributed equally to this work.

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“…Although many studies report good results using sestamibi scanning in the setting of primary hyperparathyroidism, false-positive rates for this test range from 8% to 23% [64,85,89]. Thus, although preoperative imaging may focus neck exploration in many patients, it may also increase the risk of failure in the more challenging cases [90]. The end result is conflicting data regarding the overall cost-effectiveness of preoperative localization in parathyroid surgery [91,92].…”

Section: Most Cost-effective Approachmentioning

confidence: 96%