Surgery versus Imaging in Non‐Localizing Primary Hyperparathyroidism: A Cost‐Effectiveness Model

Frank, Ethan; Watson, WayAnne; Fujimoto, Shannon; Filho, Pedro de Andrade; Inman, Jared C.; Simental, Alfred

doi:10.1002/lary.28566

Cited by 10 publications

(11 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, it is likely that the costs of PET/CT will further decrease, with newer PET cameras and software, requiring lower doses of PET radiotracers [84,86]. While there has been some suggestion that image guided MIP is more cost effective than BNE in patients with discordant first line imaging (US and MIBI) [87], this remains to be seen with FCH PET/CT. Although choline-radiolabeled agents are utilized for the imaging of prostate cancer patients, there remains an issue regarding availability of radiotracer and equipment in all imaging centers [84,88].…”

Section: Choline Pet/ctmentioning

confidence: 99%

Preoperative Localization for Primary Hyperparathyroidism: A Clinical Review

2021

View full text Add to dashboard Cite

With increasing use of minimally invasive parathyroidectomy (PTx) over traditional bilateral neck exploration in patients with primary hyperparathyroidism (PHPT), accurate preoperative localization has become more important to enable a successful surgical outcome. Traditional imaging techniques such as ultrasound (US) and sestamibi scintigraphy (MIBI) and newer techniques such as parathyroid four-dimension computed tomography (4D-CT), positron emission tomography (PET), and magnetic resonance imaging (MRI) are available for the clinician to detect the diseased gland(s) in the preoperative workup. Invasive parathyroid venous sampling may be useful in certain circumstances such as persistent or recurrent PHPT. We review the diagnostic performance of these imaging modalities in preoperative localization and discuss the advantages and weaknesses of these techniques. US and MIBI are established techniques commonly utilized as first-line modalities. 4D-CT has excellent diagnostic performance and is increasingly performed in first-line setting and as an adjunct to US and MIBI. PET and MRI are emerging adjunct modalities when localization has been equivocal or failed. Since no evidence-based guidelines are yet available for the optimal imaging strategy, clinicians should be familiar with the range and advancement of these techniques. Choice of imaging modality should be individualized to the patient with consideration for efficacy, expertise, and availability of such techniques in clinical practice.

show abstract

Section: Choline Pet/ctmentioning

confidence: 99%

Preoperative Localization for Primary Hyperparathyroidism: A Clinical Review

2021

View full text Add to dashboard Cite

show abstract

“…Nevertheless, these results should not be an excuse for avoiding or delaying surgery ( 1 ). An experienced surgeon should consider additional localization tools or proceed to bilateral neck exploration while including the patient in the decision process ( 29 ).…”

Section: Adjuvant Methods In Phpt Surgical Treatmentmentioning

confidence: 99%

Surgery for primary hyperparathyroidism

Neves¹,

Santos²,

Ohe³

2022

Archives of Endocrinology and Metabolism

View full text Add to dashboard Cite

Primary hyperparathyroidism (PHPT) is a hypercalcemic disorder that occurs when one or more parathyroid glands produces excessive parathyroid hormone (PTH). PHPT is typically treated with surgery, and it remains the only definitive therapy, whose techniques have evolved over previous decades. Advances in preoperative localization exams and the intraoperative PTH monitoring have become the cornerstones of recent parathyroidectomy techniques, as minimally invasive techniques are appropriate for most patients. Nevertheless, these techniques, are not suitable for PHPT patients who are at risk for multiglandular disease, especially in those who present with familial forms of PHPT that require bilateral neck exploration. This manuscript also explores other conditions that warrant special consideration during surgical treatment for PHPT: normocalcemic primary hyperparathyroidism, pregnancy, reoperation for persistent or recurrent PHPT, parathyroid carcinoma, and familial and genetic forms of hyperparathyroidism.

show abstract

“…Parathyroid imaging is cost saving. For instance, a study from Frank et al in 2020 found that whereas bilateral neck exploration costs $9578 with a success rate of 97.3%, single photon emission computed tomography (SPECT) imaging and minimally invasive parathyroidectomy (MIP) cost $8197 with a success rate of 98.6% (66). Contrary to some claims undermining the utility of preoperative imaging, the American Head and Neck Society (AHNS) Endocrine Section emphasized the necessity of precision preoperative localization to avoid unnecessary repeat operation (67,68) and to address the concurrent thyroid pathology, which can be identified on parathyroid imaging, in the same operation (69,70).…”

Section: Parathyroid Imaging In Current Clinical Practicementioning

confidence: 99%

Parathyroid Imaging: Past, Present, and Future

et al. 2022

View full text Add to dashboard Cite

The goal of parathyroid imaging is to identify all sources of excess parathyroid hormone secretion pre-operatively. A variety of imaging approaches have been evaluated and utilized over the years for this purpose. Ultrasound relies solely on structural features and is without radiation, however is limited to superficial evaluation. 4DCT and 4DMRI provide enhancement characteristics in addition to structural features and dynamic enhancement has been investigated as a way to better distinguish parathyroid from adjacent structures. It is important to recognize that 4DCT provides valuable information however results in much higher radiation dose to the thyroid gland than the other available examinations, and therefore the optimal number of phases is an area of controversy. Single-photon scintigraphy with 99mTc-Sestamibi, or dual tracer 99mTc-pertechnetate and 99mTc-sestamibi with or without SPECT or SPECT/CT is part of the standard of care in many centers with availability and expertise in nuclear medicine. This molecular imaging approach detects cellular physiology such as mitochondria content found in parathyroid adenomas. Combining structural imaging such as CT or MRI with molecular imaging in a hybrid approach allows the ability to obtain robust structural and functional information in one examination. Hybrid PET/CT is widely available and provides improved imaging and quantification over SPECT or SPECT/CT. Emerging PET imaging techniques, such as 18F-Fluorocholine, have the exciting potential to reinvent parathyroid imaging. PET/MRI may be particularly well suited to parathyroid imaging, where available, because of the ability to perform dynamic contrast-enhanced imaging and co-registered 18F-Fluorocholine PET imaging simultaneously with low radiation dose to the thyroid. A targeted agent specific for a parathyroid tissue biomarker remains to be identified.

show abstract

Surgery versus Imaging in Non‐Localizing Primary Hyperparathyroidism: A Cost‐Effectiveness Model

Cited by 10 publications

References 32 publications

Preoperative Localization for Primary Hyperparathyroidism: A Clinical Review

Preoperative Localization for Primary Hyperparathyroidism: A Clinical Review

Surgery for primary hyperparathyroidism

Parathyroid Imaging: Past, Present, and Future

Contact Info

Product

Resources

About