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

Abstract

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.

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

“…It was reported recently that fusion of MIBI-SPECT and CT might be helpful in patients with multiglandular disease (33). While SVS seems to be superior to MIBI-SPECT alone (18), the fusion of MIBI-SPECT and CT seems to be superior to MIBI-SPECT (34). However, to our knowledge, there has been no publication comparing the fusion of MIBI-SPECT and CT with SVS and we also have no experience of this.…”

“…SVS is usually performed via the inguinal approach. If only the large vessels; namely, the inferior and superior vena cava, the right and left innominate veins, and the right and left internal jugular veins, are catheterized, the source of parathyroid hormone over-production is often only roughly regionalized (18). The situation is made even more challenging by the fact that the venous drainage of each parathyroid gland is complex and often altered by the prior neck exploration (19).…”

Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

“…It is only appropriately performed in the setting of a remedial exploration (in patients with previously unsuccessful surgery) when non-invasive imaging studies are non-informative [92]. In one study, preoperative venous sampling had a significantly higher sensitivity (75 %) than 99m Tc-sestamibi–SPECT (30 %) [92]. …”

Selective venous sampling supports localization of adenoma in primary hyperparathyroidism

“…The precise localization afforded by SVS should benefit surgeons especially if non-invasive imaging is inconclusive. Several studies have demonstrated the feasibility of SVS (1,(8)(9)(10)(11)(12)(13)(14)(15); however, to our knowledge, few have evaluated its ability to localize the hyperfunctioning gland in patients indicated for initial surgery.…”