Factors Associated With Discordance Between Preoperative Parathyroid 4-Dimensional Computed Tomographic Scans and Intraoperative Findings During Parathyroidectomy

Sho, Shonan; Yuen, Alexander; Yeh, Michael W.; Livhits, Masha J.; Sepahdari, Ali R.

doi:10.1001/jamasurg.2017.2649

Cited by 34 publications

(41 citation statements)

References 19 publications

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“…Although we did not examine other imaging modalities in the present study, the utility of other imaging modalities such as 4D-CT in the setting of thyroid disease may also be altered. 21 Our study shows that an additional benefit of multimodal preoperative imaging with US is the identification of thyroiditis, which can aid surgeons in choosing which imaging modality to follow when planning the operative approach.…”

Section: Discussionmentioning

confidence: 77%

Discordant findings on preoperative imaging for primary hyperparathyroidism and thyroid disease: Choosing the path to follow

Beck

Kashyap

Lal

et al. 2019

Surgery

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Background: Preoperative localization of abnormal parathyroid glands in primary hyperparathyroidism is often obtained by sestamibi, and ultrasonography. We aimed to identify which modality is most accurate when laterality of abnormal glands on preoperative imaging is discordant. Methods: A single institution retrospective review identified 112 consecutive patients with primary hyperparathyroidism who underwent successful parathyroidectomy and sestamibi with pertechnetate. Results: Sestamibi with pertechnetate had a sensitivity of 72% and positive predictive value of 90%; ultrasonography had sensitivity of 50% and positive predictive value 80%. Patients with thyroiditis had lesser sensitivity and positive predictive value on sestamibi with pertechnetate (53% and 77%, respectively), in contrast to ultrasonography (54%, 88%, respectively). The sensitivity and positive predictive value of sestamibi with pertechnetate and ultrasonography did not differ in patients with thyroid nodules. Seventeen patients (15%) had discordant laterality on preoperative imaging. In discordant cases, sestamibi with pertechnetate was correct in 53% overall but in only 17% of those with thyroiditis (P ¼ .01), whereas ultrasonography was correct in 26% overall but in 50% of those with thyroiditis (P ¼ .01). Conclusion: Thyroiditis decreased the sensitivity and positive predictive value of sestamibi with pertechnetate in primary hyperparathyroidism. In patients with discordant laterality on preoperative imaging, sestamibi with pertechnetate is the more accurate choice to guide operative planning, although ultrasonography may be a better guide in those with thyroiditis.

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Section: Discussionmentioning

confidence: 77%

Discordant findings on preoperative imaging for primary hyperparathyroidism and thyroid disease: Choosing the path to follow

Beck

Kashyap

Lal

et al. 2019

Surgery

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“…Although the initial literature search returned several articles reporting 4D‐CT, none met inclusion criteria, namely discussion of imaging results in the subpopulation of interest. Whereas 4D‐CT has shown promising accuracy in difficult to localize adenomas, it is known to be negatively affected by the presence of thyroid disease . Without further data, this modality cannot be recommended in the population of patients with hyperparathyroidism and thyroid disease.…”

Section: Discussionmentioning

confidence: 99%

“…Whereas 4D-CT has shown promising accuracy in difficult to localize adenomas, 46 it is known to be negatively affected by the presence of thyroid disease. 47 Without further data, this modality cannot be recommended in the population of patients with hyperparathyroidism and thyroid disease.…”

Section: Discussionmentioning

confidence: 99%

Preoperative imaging for parathyroid localization in patients with concurrent thyroid disease: A systematic review

et al. 2018

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“…It confers ionizing radiation, uses iodinated contrast, and requires radiologist experience to accurately interpret the modality. 4DCT has limited accuracy in patients with multigland disease, small glands, or concomitant thyroid pathology [73]. Nevertheless, 4DCT has emerged as a useful and sensitive modality in the setting of reoperation.…”

Section: Four-dimensional Computed Tomographymentioning

confidence: 99%

Localization of Parathyroid Disease in Reoperative Patients with Primary Hyperparathyroidism

Parikh

Grogan

Morón

2020

International Journal of Endocrinology

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The localization of persistent or recurrent disease in reoperative patients with primary hyperparathyroidism presents challenges for radiologists and surgeons alike. In this article, we summarize the relevant imaging modalities, compare their accuracy in identifying reoperative disease, and outline their advantages and disadvantages. Accurate localization by preoperative imaging is a predictor of operative success, whereas negative or discordant preoperative imaging is a risk factor for operative failure. Ultrasound is a common first-line modality because it is inexpensive, accessible, and radiation-free. However, it is highly operator-dependent and less accurate in the reoperative setting than in the primary setting. Sestamibi scintigraphy is superior to ultrasound in localizing reoperative disease but requires radiation, prolonged imaging times, and reader experience for accurate interpretation. Like ultrasound, sestamibi scintigraphy is less accurate in the reoperative setting because reoperative patients can exhibit distorted anatomy, altered perfusion of remaining glands, and interference of radiotracer uptake. Meanwhile, four-dimensional computed tomography (4DCT) is superior to ultrasound and sestamibi scintigraphy in localizing reoperative disease but requires the use of radiation and intravenous contrast. Both 4DCT and magnetic resonance imaging (MRI) do not significantly differ in accuracy between unexplored and reoperative patients. However, MRI is more costly, inaccessible, and time-consuming than 4DCT and is inappropriate as a first-line modality. Hybrid imaging with positron emission tomography and computed tomography (PET/CT) may be a promising second-line modality in the reoperative setting, particularly when first-line modalities are discordant or inconclusive. Lastly, selective venous sampling should be reserved for challenging cases in which noninvasive modalities are negative or discordant. In the challenging population of reoperative patients with PHPT, a multimodality approach that utilizes the expertise of high-volume centers can accurately localize persistent or recurrent disease and enable curative parathyroidectomy.

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Factors Associated With Discordance Between Preoperative Parathyroid 4-Dimensional Computed Tomographic Scans and Intraoperative Findings During Parathyroidectomy

Cited by 34 publications

References 19 publications

Discordant findings on preoperative imaging for primary hyperparathyroidism and thyroid disease: Choosing the path to follow

Discordant findings on preoperative imaging for primary hyperparathyroidism and thyroid disease: Choosing the path to follow

Preoperative imaging for parathyroid localization in patients with concurrent thyroid disease: A systematic review

Localization of Parathyroid Disease in Reoperative Patients with Primary Hyperparathyroidism

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