Reoperative parathyroidectomy: An algorithm for imaging and monitoring of intraoperative parathyroid hormone levels that results in a successful focused approach

Wang, Tracy; Doffek, Kara; Krzywda, Elizabeth A.; Wilson, Stuart D.

doi:10.1016/j.surg.2008.06.017

Cited by 103 publications

(69 citation statements)

References 17 publications

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“…4D-CT also has the advantage of better identifying ectopic parathyroid glands that are commonly found in conditions of recurrent or persistent PHPT disease. Magnetic resonance has been reported to have a sensitivity of 67% in patients re-operated (33). If mediastinal parathyroid adenoma is suspected, at least one of these two last imaging techniques is mandatory to assist in the transthoracic operative approach (i.e.…”

Section: Availability Of Rapid Pth Assaymentioning

confidence: 99%

Imaging of the parathyroid glands in primary hyperparathyroidism

Minisola¹,

Cipriani²,

Diacinti³

et al. 2016

European Journal of Endocrinology

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Primary hyperparathyroidism (PHPT) is one of the most frequent endocrine diseases worldwide. Surgery is the only potentially curable option for patients with this disorder, even though in asymptomatic patients 50 years of age or older without end organ complications, a conservative treatment may be a possible alternative. Bilateral neck exploration under general anaesthesia has been the standard for the definitive treatment. However, significant improvements in preoperative imaging, together with the implementation of rapid parathyroid hormone determination, have determined an increased implementation of focused, minimally invasive surgical approach. Surgeons prefer to have a localization study before an operation (both in the classical scenario and in the minimally invasive procedure). They are not satisfied by having been referred a patient with just a biochemical diagnosis of PHPT. Imaging studies must not be utilized to make the diagnosis of PHPT. They should be obtained to both assist in determining disease etiology and to guide operative procedures together with the nuclear medicine doctor and, most importantly, with the surgeon. On the contrary, apart from minimally invasive procedures in which localization procedures are an obligate choice, some surgeons believe that literature on parathyroidectomy over the past two decades reveals a bias towards localization. Therefore, surgical expertise is more important than the search for abnormal parathyroid glands.

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Section: Availability Of Rapid Pth Assaymentioning

confidence: 99%

Imaging of the parathyroid glands in primary hyperparathyroidism

Minisola¹,

Cipriani²,

Diacinti³

et al. 2016

European Journal of Endocrinology

View full text Add to dashboard Cite

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“…The non-invasive techniques used for this include ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), sestamibi scintigraphy (MIBI), and methionine-PET). Before reoperation, the sensitivity of US, CT, MRI, MIBI, and methionine-PET has been reported at 20-80 % (7-11), 40-90 % (9,11,12), 65-80 % (8,11,12), 50-90 % (8,9,(11)(12)(13), and about 80% (14), respectively.…”

Section: Introductionmentioning

confidence: 99%

Super-selective venous sampling in conjunction with quickPTH for patients with persistent primary hyperparathyroidism: report of five cases

Gimm

Arnesson²,

Olofsson³

et al. 2012

Surg Today

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“…The diagnostic value of SVS is based on the assumption that the regional drainage of each one of the four parathyroid glands is into the adjacent superior, middle, and inferior thyroid veins respectively (20). Despite potential anatomical variations, SVS is successful in predicting the side of a pathological parathyroid gland in 39-93% of patients with PHPT (20)(21)(22)(24)(25)(26)(27)(28)(29)(30)(31) and, more importantly, in 66-75% of patients with negative noninvasive studies (21,27,32). The major limitation of SVS, however, is that it pinpoints the area of venous drainage of a hyperactive gland rather than its exact anatomical location.…”

Section: Introductionmentioning

confidence: 99%

The role of selective venous sampling in the management of persistent hyperparathyroidism revisited

Witteveen¹,

Kievit²,

Erkel³

et al. 2010

European Journal of Endocrinology

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Introduction: Localization studies are mandatory prior to revision surgery in patients with persistent hyperparathyroidism in order to improve surgical outcome and reduce the risk of lengthy explorations. However, in this case, noninvasive localization studies are reported to have a poor sensitivity. The aim of our study is to determine the accuracy of selective venous sampling (SVS) for parathyroid hormone (PTH) in localizing residual hyperactive parathyroid glands in patients with persistent or recurrent hyperparathyroidism. Patients and methods: We retrospectively evaluated the localizing accuracy of 20 PTH SVS performed prior to revision surgery in 18 patients with persistent or recurrent primary hyperparathyroidism (nZ11) or autonomous (tertiary) hyperparathyroidism (nZ7). Tc99m-methoxy-isobutyle-isonitrile (MIBI)-single photon emission computed tomography (SPECT) was also performed in all patients prior to revision surgery. Operative and pathological data were obtained from hospital records. Results: The SVS was able to accurately localize 15 of the 20 pathological glands removed at revision surgery, representing a sensitivity of 75%. This sensitivity is significantly higher than that of Tc99m-MIBI-SPECT, which was only 30% (PZ0.012).Conclusion: Our findings demonstrate that SVS is a valuable localization study in patients with persistent or recurrent hyperparathyroidism, with a sensitivity significantly higher than that of Tc99m-MIBI-SPECT. Our data suggest that SVS represents a useful addition to the preoperative workup of these patients prior to revision surgery.

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Reoperative parathyroidectomy: An algorithm for imaging and monitoring of intraoperative parathyroid hormone levels that results in a successful focused approach

Cited by 103 publications

References 17 publications

Imaging of the parathyroid glands in primary hyperparathyroidism

Imaging of the parathyroid glands in primary hyperparathyroidism

Super-selective venous sampling in conjunction with quickPTH for patients with persistent primary hyperparathyroidism: report of five cases

The role of selective venous sampling in the management of persistent hyperparathyroidism revisited

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