Value of 123I/99mTc-sestamibi parathyroid scintigraphy with subtraction SPECT/CT in primary hyperparathyroidism for directing minimally invasive parathyroidectomy

Asseeva, Pauline; Paladino, Nunzia Cinzia; Guérin, Carole; Castinetti, Frédéric; Vaillant-Lombard, Josiane; Abdullah, Ahmad Esmaeel; Farman-Ara, Bardia; Loundou, Anderson; Sébag, F.; Taïeb, David

doi:10.1016/j.amjsurg.2018.06.027

Cited by 14 publications

(8 citation statements)

References 19 publications

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“…Several previous publications have assessed imaging setups similar to ours. A combination of subtraction pinhole and subtraction SPECT/CT (i.e., our dual/dual setup) has previously been found to have sensitivity similar to ours or higher (81%–98%) and varying specificity (67%–99%) [ 11 , 12 , 13 ]. In these studies the removed parathyroid glands were somewhat larger than in the present study (average size 700–1420 mg, compared to 544 mg in the present study) which, as mentioned, would likely increase sensitivity.…”

Section: Discussionsupporting

confidence: 52%

“…In these studies the removed parathyroid glands were somewhat larger than in the present study (average size 700–1420 mg, compared to 544 mg in the present study) which, as mentioned, would likely increase sensitivity. Furthermore, there is a difference in imaging criteria; i.e., Asseeva et al discriminate between “uniglandular disease”, “multiglandular disease” and “negative result” while we discriminate by the location of HPGs [ 11 ]. Due to the limited sensitivity of the dual/single method, Krčálová et al recommend adding subtraction SPECT/CT (i.e., dual/dual) or 18F-fluorocholin-positron emission tomography / computed tomography (PET/CT) in order to increase sensitivity [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Added Value of Subtraction SPECT/CT in Dual-Isotope Parathyroid Scintigraphy

Christensen

Krakauer

2020

Diagnostics

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Background: Adding subtraction single-photon emission computed tomography/computed tomography (SPECT/CT) to dual isotope (I-123 and Tc-99m-sestamibi) subtraction parathyroid scintigraphy is not widely implemented. We aimed to assess the added value of dual isotope subtraction SPECT/CT over single isotope SPECT/CT as an adjunct to dual isotope planar pinhole subtraction scintigraphy. Methods: Parathyroid scintigraphies from 106 patients with an estimated total of 415 parathyroid glands who (1) were diagnosed with primary hyperparathyroidism, (2) underwent dual isotope subtraction scintigraphy in the Department of Nuclear Medicine, Gentofte Hospital, Denmark throughout 2017 and (3) underwent subsequent parathyroidectomy, were included. The original dual isotope planar pinhole subtraction plus dual isotope subtraction SPECT/CT (dual/dual method) exams were retrospectively re-evaluated using only Tc-99m-sestamibi SPECT/CT (dual/single method). Statistics were calculated per parathyroid. Surgical results confirmed by pathology served as reference standard. Results: The dual/dual method had higher sensitivity than the dual/single method (82% (95%CI 74%–88%) vs. 69% (95%CI 60%–77%)) while specificity, positive and negative predictive values (PPV and NPV) were similar (specificity 96% vs. 93%, PPV’s 87% vs. 82% and NPV’s 89% vs. 93%). Reader confidence was higher when employing the dual/dual method (p = 0.001). Conclusions: The dual/dual method can be considered superior to the dual/single method in the preoperative imaging in primary hyperparathyroidism.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Added Value of Subtraction SPECT/CT in Dual-Isotope Parathyroid Scintigraphy

Christensen

Krakauer

2020

Diagnostics

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“…Of 119 studies, 48 were performed in a prospective manner. The sensitivity on a per-patient–based analysis was available in 84 studies (Table 1), whereas the sensitivity on a per-lesion–based analysis was available in 39 studies (Table 2). Of the 84 patient-based studies, 47 were reported before 2009, and 37 were reported after 2010.…”

Section: Resultsmentioning

confidence: 99%

Direct Comparison of Preoperative Imaging Modalities for Localization of Primary Hyperparathyroidism

Lee

Shim

Jeong

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Accurate preoperative localization of primary hyperparathyroidism (pHPT) is an important and challenging issue for a successful parathyroidectomy. Although new imaging modalities have been introduced during the past decade, direct comparative studies on advanced imaging techniques are limited.OBJECTIVE To compare the performance of different preoperative imaging modalities for the localization of pHPT by performing a network meta-analysis (NMA).

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“…Parathyroid surgery is considered a procedure whose strategic approach requires considerable specific expertise, especially in choosing the indication for surgery and the technique to use, as well as determining the extent of dissection 3 , 8 , 22 , 23 . The development of localization imaging has unquestionably improved the chances of correctly identifying hyperfunctioning parathyroid tissue 2 , 3 , 13 , 23 , 24 . IoPTH has attracted interest since its launch because of its capacity to validate, during the execution of surgery, the removal of all pathological parathyroid tissue or the incompleteness of the procedure 4 , 5 .…”

Section: Discussionmentioning

confidence: 99%

“…The introduction of ioPTH and the optimization of its interpretative models, together with the refinement of techniques for localization of pathological parathyroid glands have allowed the implementation of focused approach for PTx 13 , 14 and the extension of surgical indications, with an overall improvement of treatment optimization, especially in terms of complications of HPT1 15 . In addition, ioPTH may be a useful tool in difficult settings, such as concurrent thyroid disease or unlocalized parathyroid gland 16 , 17 .…”

Section: Introductionmentioning

confidence: 99%

Interpretation of intraoperative parathyroid hormone monitoring according to the Rome criterion in primary hyperparathyroidism

Graceffa

Cipolla

Calagna

et al. 2022

Sci Rep

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Intraoperative parathyroid hormone dosage allows real-time monitoring of the decrease in PTH levels during parathyroidectomy and verify procedure’s efficacy. Currently, none of the interpretative criteria used has absolute accuracy. The aim of this study is to evaluate diagnostic accuracy of the Rome criterion verifying diagnostic significance of the individual assays. A total of 205 patients with primary hyperparathyroidism from a single adenoma were retrospectively evaluated and monitored with baseline PTH, PTH at 10 min and PTH at 20 min after adenoma excision. The accuracy of the latter two assays compared with baseline was compared by ROC curves. In addition, was evaluated the influence on these data of localization diagnostics (ultrasounds and scintigraphy), definitive histology, and type of surgery performed. The ratio of 20-min sampling to baseline in the Rome criterion showed highest diagnostic significance. This finding was not influenced by the type of surgery performed, definitive histologic examination, or intraoperative localization of the adenoma. The Rome criterion has shown its high reliability in detecting persistence. The ratio of sampling at 20 min to baseline is by far the best performing. Further studies are needed to evaluate whether sampling at 10 min after adenoma excision can be considered not mandatory.

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Value of 123I/99mTc-sestamibi parathyroid scintigraphy with subtraction SPECT/CT in primary hyperparathyroidism for directing minimally invasive parathyroidectomy

Cited by 14 publications

References 19 publications

Added Value of Subtraction SPECT/CT in Dual-Isotope Parathyroid Scintigraphy

Added Value of Subtraction SPECT/CT in Dual-Isotope Parathyroid Scintigraphy

Direct Comparison of Preoperative Imaging Modalities for Localization of Primary Hyperparathyroidism

Interpretation of intraoperative parathyroid hormone monitoring according to the Rome criterion in primary hyperparathyroidism

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