Direct Comparison of Preoperative Imaging Modalities for Localization of Primary Hyperparathyroidism

Lee, Sang‐Woo; Shim, Sung Ryul; Jeong, Shin Young; Kim, Seong-Jang

doi:10.1001/jamaoto.2021.0915

Cited by 33 publications

(34 citation statements)

References 147 publications

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“…7,8 Increased use and familiarity among surgeons heralded a new era of preoperative preparation and postoperative evaluation in thyroid and parathyroid disease. Meanwhile, numerous new technologies have been developed for parathyroid identification, notably choline positron emission tomography-computed tomography, 9 assays of parathyroid autofluorescence, 10 and gamma probe-aided identification of Tc99m sestamibi-labeled parathyroid glands. 11 Previous work suggested normal parathyroid glands may be hyperechoic and homogeneous on ultrasound, although gland identity was never confirmed by histopathological, biochemical, or fluorescence review.…”

Section: Discussionmentioning

confidence: 99%

“…Increased use and familiarity among surgeons heralded a new era of preoperative preparation and postoperative evaluation in thyroid and parathyroid disease. Meanwhile, numerous new technologies have been developed for parathyroid identification, notably choline positron emission tomography–computed tomography, 9 assays of parathyroid autofluorescence, 10 and gamma probe‐aided identification of Tc99m sestamibi‐labeled parathyroid glands 11 …”

Section: Discussionmentioning

confidence: 99%

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Ultrasound Identification of Normal Parathyroid Glands

Cohen¹,

Noel²,

Puccinelli³

et al. 2021

OTO Open

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Ultrasound has become indispensable for identification of thyroid and parathyroid pathology, but normal parathyroid glands have historically been considered too subtle to accurately detect. Inability to identify and protect parathyroid glands can result in hypoparathyroidism and hypocalcemia during thyroidectomy surgery as well as misinterpretation of central neck structures in the postoperative neck. Advances in ultrasound resolution have opened the door to novel applications for this technology. In this study, we report the first surgeon-performed ultrasound identification of normal parathyroid glands in a series of 6 patients, confirmed by parathyroid tissue aspirate or parathyroid autofluorescence. Recognition of normal parathyroid glands using ultrasound can be valuable for preventing postoperative hypoparathyroidism and in increasing the accuracy of postsurgical ultrasound surveillance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ultrasound Identification of Normal Parathyroid Glands

Cohen¹,

Noel²,

Puccinelli³

et al. 2021

OTO Open

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“…Several studies have proposed preoperative localization procedures that are more sensitive to detect multiglandular disease, small lesions, or possible ectopic parathyroid tissue in MEN1-related PHPT, such as 18F-fluorocholine PET/CT (FCH-PET/CT), with or without enhanced arterial imaging, and four-dimensional computed tomography (4D-CT), especially when conventional preoperative imaging before the first intervention is inconclusive [ 19 , 20 , 21 , 22 ]. In particular, the performance of 18F-FCH-PET/CT in PHPT appears to be superior compared to commonly used imaging using 99m Tc-sestamibi scintigraphy, ultrasound, and 4D-CT [ 21 , 23 , 24 , 25 , 26 ], and provides valuable information even in cases with recurrent disease and negative or equivocal 99m Tc-sestamibi scintigraphy and/or ultrasound.…”

Section: Discussionmentioning

confidence: 99%

Management and Long-Term Follow-Up of Hyperparathyroidism in Multiple Endocrine Neoplasia Type 1: Single Center Experience

Yavropoulou

Vlachou

Tsoli

et al. 2022

JCM

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Background: Primary hyperparathyroidism (PHPT) in the most common and earliest manifestation of multiple endocrine neoplasia type-1 (MEN1). Epidemiological data have been reported in MEN1 patients but data on long-term follow-up focusing on PHPT are scarce. Methods: In this retrospective cohort study, we included patients diagnosed with MEN1-related PHPT that were under regular follow-up in our institution. Results: Data on 68 patients (39 males), with a mean age at MEN1-diagnosis of 39 ± 13.06 years, were analyzed. Pancreatic neuroendocrine tumors were encountered in 82% (71% nonsecreting) followed by pituitary adenomas in 66% (49% nonsecreting). Mean age at PHPT diagnosis was 35.2 ± 4.0 years. Parathyroidectomy was performed in 57 patients (82.3%), of whom 56% achieved long-term remission, while 12.2% and 31.5% had persistent and recurrent disease, respectively (median follow-up of 4 years; range 1–21 years). Cinacalcet restored serum calcium levels in 33.8%, both as first and as a second line treatment. Permanent hypoparathyroidism occurred in 19.2%. MEN1 pathogenic variants were identified in 77.2% of the tested individuals, but no genotype-phenotype associations were reported. Conclusions: MEN1-related PHPT involves a multiglandular disease and its management remains a therapeutic challenge, as recurrent disease can develop even after 20 years of follow-up. Prolonged follow-up of these patients at referral centers is critical for their optimal management.

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“…In 2021, Bioletto et al meta-analyzed 22 studies (8 evaluating the diagnostic value of [ 11 C]MET and 14 evaluating [ 18 F]FCH), stating that in the preoperative diagnosis of pHPT, the sensitivity of [ 18 F]FCH is higher than the sensitivity of [ 11 C]MET (92% and 80%, p < 0.01); however, both radiotracers have a similar positive predictive value (94% for [ 18 F]FCH and 95% for [ 11 C]MET, p = 0.99) [ 24 ]. In 2021, Lee et al conducted a meta-analysis in which they enrolled 8495 patients from 119 studies comparing the use of at least two preoperative imaging techniques in pHPT [ 25 ]. By analyzing the area under the cumulative ranking curve (SUCRA) for PET/CT using [ 18 F]FCH, PET/CT with [ 11 C]MET, planar scintigraphy, single-photon emission computed tomography (SPECT) scintigraphy, as well as ultrasound and 4D-CT, we estimated the probability with which a given imaging technique may be useful for this type of diagnostics.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of PET/CT with Carbon-11-Labeled Methionine in the Diagnosis of Tertiary Hyperparathyroidism

Kołodziej

Saracyn

Lubas³

et al. 2022

Nutrients

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Introduction: Tertiary hyperparathyroidism (tHP) may develop in patients treated with hemodialysis or peritoneal dialysis. Parathyroidectomy may result in a significant reduction in the severity of symptoms. For the effective surgical treatment of hyperparathyroidism, proper localization of the parathyroid glands prior to surgery is essential. The sensitivity of scintigraphy in the diagnosis of tHP is lower than in the diagnosis of primary hyperparathyroidism. In recent years, positron emission tomography (PET/CT) has been gaining importance, usually as a complementary technique. Aim: The aim of this study was to determine the usefulness of PET/CT with [11C]MET in the preoperative localization diagnosis of patients with tertiary hyperparathyroidism caused by chronic kidney disease, in whom first-line diagnostic methods did not allow the localization of pathologically parathyroid glands. Material and methods: The study was conducted in a group of 19 adult patients with severe tHP who were resistant or intolerant to non-invasive treatment, with negative results of scintigraphy and ultrasonography of the neck. The study protocol included measurement of the concentration of calcium, phosphorus, and PTH in the blood serum and performing PET/CT with [11C]MET. Results: A positive result of PET/CT was obtained in 89.5% of the patients (17/19). Parathyroidectomy was performed in 52.9% of the patients (9/17) with positive results of PET/CT with [11C]MET, which were fully consistent with the results of the histopathological examinations of the removed parathyroid glands. On this basis, the sensitivity of PET/CT with [11C]MET in the preoperative localization diagnosis of patients with tHP was found to be 100%. Multiple lesions were visualized in 57.9% of the patients (11/19). Ectopic lesions were visualized in 21.1% of the patients (4/19). Conclusions: PET/CT with [11C]MET is a sensitive technique for the second-line preoperative imaging of parathyroid glands in patients with tertiary hyperparathyroidism in whom first-line examinations, such as ultrasound and scintigraphy, has failed.

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Direct Comparison of Preoperative Imaging Modalities for Localization of Primary Hyperparathyroidism

Cited by 33 publications

References 147 publications

Ultrasound Identification of Normal Parathyroid Glands

Ultrasound Identification of Normal Parathyroid Glands

Management and Long-Term Follow-Up of Hyperparathyroidism in Multiple Endocrine Neoplasia Type 1: Single Center Experience

Usefulness of PET/CT with Carbon-11-Labeled Methionine in the Diagnosis of Tertiary Hyperparathyroidism

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