Noninvasive localization procedures in ectopic hyperfunctioning parathyroid tumors.

Abstract

In primary hyperparathyroidism (pHPT), parathyroidectomy is the treatment of choice, but anatomic variations of ectopic glands may cause surgical failure. Reliable preoperative noninvasive localization procedures would have a positive impact on the operative time and increase recovery rate. We retrospectively evaluated 186 patients with pHPT who were studied before successful parathyroidectomy by double tracer scintigraphy (99mTc-pertechnetate+201TI chloride or 99mTc-pertechnetate +99mTc-sestamibi, 160 patients), ultrasonography (148 patients) and computerized tomography (CT) scan (92 patients). During bilateral neck exploration, 159 (85.5%) single adenomas, 6 (3.2%) parathyroid carcinomas, and 3 (1.6%) double adenomas were found. Moreover, 18 (9.7%) patients had diffuse chief cells parathyroid hyperplasia. Removed parathyroid glands were in ectopic sites in 41 (22.0%) cases, mainly localized in the upper mediastinum or behind the esophagus. The overall sensitivity was 83.5 and 85.2% for 99mTc-pertechnetate+201TI chloride and 99mTc-pertechnetate+99mTc-sestamibi scintigraphy respectively, 80.4% for CT scan and 81.1% for ultrasonography. In patients with ectopic glands, sensitivity was 81.2, 79.5, 73.3 and 81.6% respectively. In 36 out of 41 patients with ectopic glands in whom the removed parathyroids were correctly localized, mean operative time was 95 min, and in 5 patients without preoperative localization it was 260 min. In conclusion, in pHPT, preoperative localization of an enlarged parathyroid is helpful, especially in ectopic adenomas and in anatomic variations in location, and it has been proved to reduce operative time and morbidity rate.

Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism

“…Different techniques were used in performing PT scintigraphy, both with 99m Tc-sestamibi alone (12,29,30) and 99m Tc-sestamibi in conjunction with 123 I or 99m Tcpertechnetate for thyroid image subtraction (9,26,27), with similar results. Dual phase imaging with single-photon emission computer tomography (SPECT) seems to be a promising procedure for the detection of hyperfunctioning PT tissue, both increasing the sensitivity of 99m Tc-sestamibi scintigraphy and appearing particularly useful in localizing mediastinal glands (38,39).…”

“…Three more images were acquired after 150 MBq 99m Tc-pertechnetate administration. Image subtraction was obtained according to standard techniques and positive scan imaging was defined as a relative increased sestamibi uptake area persisting after images subtraction, as previously described (9).…”

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.

“…However, most studies suggested that preoperative localization of abnormal parathyroid glands may be useful in reducing operative time, morbidity and hospital stay, facilitating parathyroidectomy especially in patients with ectopic parathyroid tumours (Wei & Burke 1995, Sfakianakis et al 1996, Gupta et al 1998, Sofferman & Nathan 1998, Vogel et al 1998, Boggs et al 1999, Chen et al 1999, Lumachi et al 1999, Song et al 1999. Table 5 shows the results obtained from series in which two or more procedures were compared.…”

“…There were 78 (26.9%) men and 185 (73.1%) women, with a median age of 57 years (range 13-82 years). The main preoperative laboratory data are reported in (Zotti et al 1984, Borsato et al 1989, Lumachi et al 1999. Computed tomography scan images were obtained using standard contiguous 5 mm sections after intravenous radiographic contrast administration and spiral CT was available for 21/92 (22.8%) patients.…”

Salient Anatomical Landmarks of Thyroid and Their Practical Significance in Thyroid Surgery: a Pictorial Review of Thyroid Surgical Anatomy (Revisited)

“…Approach through TCS keeps the great vessels of the neck under vision and away from the area of dissection during thyroidectomy. TCS is also one of the sites of ectopic parathyroid adenomas [44].…”