Role of Imaging Tests for Preoperative Location of Pathologic Parathyroid Tissue in Patients with Primary Hyperparathyroidism

Coelho, Maria Caroline Alves; Morais, Nathalie de Oliveira e Silva de Anne; Beuren, Andrea Cristiani; Lopes, Cristiane Bertolino; Santos, Camila Vicente dos; Cantoni, Joyce; Neto, Leonardo Vieira; Lima, Maurício B.

doi:10.4158/ep151137.or

Cited by 9 publications

(4 citation statements)

References 21 publications

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“…8,18,21 Rates of ultrasound accuracy range from 70% to 85%, although reviews suggest that ultrasound has a higher positive predictive value than sestamibi scintigraphy and may be used alone. 22,24 The aim of this study was to determine the most accurate preoperative localisation technique in primary hyperparathyroidism in a district general hospital setting.…”

Section: Introductionmentioning

confidence: 99%

Combined ultrasound and Sestamibi scintigraphy provides accurate preoperative localisation for patients with primary hyperparathyroidism

Sean

Marsden

Kyrimi

et al. 2019

annals

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Introduction Minimally invasive parathyroidectomy has advantages over the traditional bilateral neck exploration for the surgical treatment of primary hyperparathyroidism. It requires accurate localisation of the parathyroid pathology prior to surgery. The best method of preoperative localisation in a district general hospital setting is not well understood. Methods All patients who underwent parathyroidectomy for primary hyperparathyroidism from 2008 to 2016 were identified from a prospectively maintained database. Operative findings were correlated with radiological and histological results. Sensitivity and specificity of ultrasound, sestamibi scintigraphy and the two together were calculated for diagnostic precision and compared. Results One hundred and eighty-four patients met the inclusion criteria, of whom 81.5% had a histological diagnosis of a parathyroid adenoma. Ultrasound had higher sensitivity than sestamibi scintigraphy. Used together, ultrasound and sestamibi scintigraphy performed better than either ultrasound or sestamibi scintigraphy alone (P< 0.001). Twenty-two of 184 cases had no lesion located by either ultrasound or sestamibi scintigraphy preoperatively. Where neither ultrasound nor sestamibi scintigraphy located the lesion, additional computed tomography led to the excision of parathyroid pathology in one in ten patients. Conclusion The combination of ultrasound and sestamibi scintigraphy provides the highest sensitivity of preoperative localisation. This approach led to a high success rate of minimally invasive parathyroidectomy. Where preoperative localisation is not achieved with ultrasound or sestamibi scintigraphy, computed tomography adds little additional benefit. In this setting other modalities of localisation such a selective venous sampling, intraoperative methylene blue or intraoperative parathyroid hormone levels could be considered.

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Section: Introductionmentioning

confidence: 99%

Combined ultrasound and Sestamibi scintigraphy provides accurate preoperative localisation for patients with primary hyperparathyroidism

Sean

Marsden

Kyrimi

et al. 2019

annals

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“…Additional imaging using neck USG is helpful for selecting FP in most PHPT patients with negative MIBI scan results (13,22). In addition, with the increasing accuracy of preoperative localisation studies, there is a growing discussion on whether IOPTH is necessary (10,23,24). The present results indicate that selection of the appropriate operation method with preoperative localisation studies eliminates discordance as a risk factor for recurrence and persistent Whether hyperplasia is present before and during parathyroidectomy cannot be determined.…”

Section: Discussionmentioning

confidence: 82%

Selection of parathyroidectomy methods for primary hyperparathyroidism according to concordance between ultrasonography and MIBI scan results

et al. 2021

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Background: Determination of appropriate operative methods for primary hyperparathyroidism (PHPT) is difficult when localisation results are discordant between imaging studies. The aim of this study was to compare the efficacy of focused parathyroidectomy (FP) and bilateral neck exploration (BNE) according to the concordance in localisation results.Method: One hundred and ninety-one patients who underwent a PHPT operation at Asan Medical Center between 2000 and 2010 were divided into two groups according to the concordance in findings between neck ultrasonography (USG) and sestamibi (MIBI) scan. Differences in clinicopathological features and surgical outcomes between the concordant (n=137) and discordant (n=54) groups were analysed.Results: FP and BNE did not show significant differences in postoperative persistent hyperparathyroidism rates. Although intraoperative parathyroid hormone (IOPTH) monitoring was not performed in this study, the cure rates of PHPT using only USG and MIBI scans were satisfactorily high, at 98.5% in the concordant group and 96.3% in the discordant group. The cure rates of FP and Unilateral exploration in single-negative USG and MIBI scans were 100%. Multiple lesions and hyperplasia were more common in the discordant group. Conclusions:In cases where it is difficult to apply IOPTH, FP without IOPTH is feasible in patients showing concordant or single-negative detection on USG and MIBI scans, whereas BNE is recommended in cases of discordance or double-negative results on imaging studies, to prevent recurrence or persistent disease. Appropriate selection of parathyroidectomy methods according to the concordance in USG and MIBI scans might produce good results without any difference in recurrence.

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“…[29,30,33] There is no generally accepted algorithm for the use of USG or scintigraphy as the first-line test in the imaging of pHPT. [7,29] In some studies, it was found that the pathological gland could detect the USG and the first USG must be selected, [27,34,35] others had higher efficacy of scintigraphy and scintigraphy was recommended as the first test. [21] In some studies, the combination of scintigraphy and USG has been suggested to increase the sensitivity, and the use of these methods in combination was recommended.…”

Section: Discussionmentioning

confidence: 99%

Primer Hiperparatiroidili Hastalarda Preoperatif Ultrasonografi Ve Sintigrafinin İlk Görüntülemede Patolojik Bezin Lokalizasyonunda Etkinliği

2019

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Objectives: Primary hyperparathyroidism (pHPT) is a common disease, and its curative treatment is surgical. Nowadays, preoperative localization studies have become standard before surgical treatment, and the first stage imaging methods are ultrasonography and/or scintigraphy. With the contribution of these studies to the localization of the pathological gland, focused surgery has become the first standard of choice. In this study, we aimed to evaluate the efficacy of ultrasonography and scintigraphy in the preoperative localization of the pathologic gland or glands in patients who underwent surgical treatment and cure for pHPT. Methods: In this study; the data of the biochemically diagnosed pHPT patients, who had Tc 99m-MIBI scintigraphy and/or ultrasonography for localisation preoperatively, were evaluated retrospectively. The lesion, which was positive in USG or scintigraphy for localization, was evaluated according to the neck side or neck quadrant, and the results were compared with intraoperative localization findings. The effectiveness of both methods and combinations was evaluated with the localization rates, sensitivity and positive predictive values (PPV). The three methods were compared with the Youden index (J). Results: The mean age of 380 patients included in this study was 54.8±12.8 years (20-83). Three hundred eight of them were female, and 72 were male. Scintigraphy was performed in 339 patients, USG was performed in 344 patients, and both USG and scintigraphy were performed in 306 patients. One hundred twenty patients (32%) underwent bilateral neck exploration (BNE), and 260 patients (68.4%) underwent minimally invasive parathyroidectomy (MIP) (unilateral exploration or focused surgery). Single adenoma was detected in 358 (94%), double adenoma in 10 (3%) and hyperplasia in 12 (3%) patients. Localization rates of USG, scintigraphy, USG and scintigraphy combinations were 53%, 74%, 75%; their sensitivity was 56%, 85%, 89%; PPDs were 90%, 86%, 83%. The efficiency of scintigraphy is higher than USG (J: 0.743 vs 0.527). The contribution of scintigraphy to USG in combination with USG was limited (J: 0.743 vs 0.754). The localization rates of USG, scintigraphy, USG and scintigraphy combinations were 46%, 64%, 66%; their sensitivity was 51%, 83%, 88%; PPDs were 79%, 74%, 73%. The efficiency of scintigraphy is higher than that of USG (J: 0.64 vs 0.427). The contribution of scintigraphy to USG in combination with USG was limited (J: 0.64 vs 0.66). Conclusion: In patients with pHPT, scintigraphy is a more effective method for USG as the first step preoperative imaging and should be preferred as the first method if there is no contraindication. A combination of scintigraphy with USG may contribute minimally to the efficacy of scintigraphy. It may be advantageous for early detection of the pathologic gland in patients with incompatible two imaging and initiating surgery on the positive side of the first scintigraphy. Scintigraphy and USG methods may allow successful MRP surgery in the majority of patients with...

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Role of Imaging Tests for Preoperative Location of Pathologic Parathyroid Tissue in Patients with Primary Hyperparathyroidism

Cited by 9 publications

References 21 publications

Combined ultrasound and Sestamibi scintigraphy provides accurate preoperative localisation for patients with primary hyperparathyroidism

Combined ultrasound and Sestamibi scintigraphy provides accurate preoperative localisation for patients with primary hyperparathyroidism

Selection of parathyroidectomy methods for primary hyperparathyroidism according to concordance between ultrasonography and MIBI scan results

Primer Hiperparatiroidili Hastalarda Preoperatif Ultrasonografi Ve Sintigrafinin İlk Görüntülemede Patolojik Bezin Lokalizasyonunda Etkinliği

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