Parathyroid adenoma screening efficacies of different imaging tools and factors affecting the success rates (original) (raw)
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Utility of surgeon-performed pre-operative ultrasound in the localisation of parathyroid adenomas
JRSM Cardiovascular Disease, 2019
Background Primary hyperparathyroidism arising from parathyroid adenoma is one of the most common endocrine disorders treated by endocrine surgeons. The adenoma is commonly identified by imaging techniques. The present study evaluated the performance of a portable ultrasound machine (Sonosite MicroMaxx) operated by a surgeon, departmental ultrasound and 99mTc-sestamibi-SPECT/CT by a radiologist in the identification of parathyroid adenomas. Methods Patient case notes were retrieved from medical records and imaging from picture archiving and communication system over the period from 2006 to 2012. 99mTc-sestamibi-SPECT/CT and departmental ultrasound images were reported by a nuclear radiologist. The ability of each imaging technique in localising parathyroid adenomas was referenced against the actual adenomas identified from parathyroidectomy. Results With reference to the actual site of the lesion, surgeon-performed ultrasound accurately localised the site of the lesion in 30/33 (90....
Head & Neck, 2002
Background. Unilateral parathyroid exploration with adenoma removal and identification of a normal parathyroid gland is a controversial surgical approach to the treatment of primary hyperparathyroidism. The aim of this study was to evaluate the ability of high-resolution ultrasonography to localize adenomas preoperatively and to assess the effect of such localization on operative time.
Parathyroid adenoma imaging-preoperative localization
ARS Medica Tomitana, 2015
ABSTRACTPrimary hyperparathyroidism (PHPT) is a frequent endocrine disorder that can only be cured by a surgical procedure that is parathyroidectomy. The main causes are usually solitary benign adenoma (80-85%), diffuse or nodular hyperplasia (10-15%), or parathyroid carcinoma (<1%). Out of the known localization techniques, ultrasonography, nuclear scintigraphy and computer tomography (CT scan) are most commonly used [1].The aim of this study is to evaluate the sensibility of ultrasonography by comparison to scintigraphy and CT scan for the preoperative localization of parathyroid adenoma in patients with biochemically confirmed primary hyperparathyroidism. Localization studies were correlated with intraoperative findings, histopathological outcomes. In a retrospective study we analyzed 60 patients out of 245 patients who had undergone parathyroidectomy for PHPT between 2012-2013 in the Surgery Department of the National Institute of Endocrinology, Bucharest.Preoperative evaluat...
Ultrasonography: Highly Accuracy Technique for Preoperative Localization of Parathyroid Adenoma
Laryngoscope, 2008
Objectives/Hypothesis: This study evaluates the accuracy of ultrasonography in guided unilateral parathyroidectomy to treat primary hyperparathyroidism. Study Design: Retrospective study. Methods: Two hundred fifty-three patients with primary hyperparathyroidism underwent preoperative ultrasonography. Two groups were defined. Group 1 included the patients in whom the preoperative cervical ultrasound localized one abnormal parathyroid gland; these patients underwent unilateral surgical exploration of the neck under local anesthesia. Group 2 included the patients who had a bilateral neck exploration under general anesthesia when the preoperative examination was equivocal or failed to localize the lesion, when concomitant thyroid pathology indicated thyroidectomy, and when justified by the surgical findings. Results: Sensitivity and positive predictive value of ultrasonography in detecting abnormal parathyroid gland were 96% and 98%, respectively. Cervical ultrasound correctly identified, 96% and 85% of abnormal glands in groups 1 and 2, respectively. The presence of thyroid nodular disease did not affect ultrasonographic accuracy. Sonographic examination decreased the operative time of parathyroidectomy to an average of 15 minutes. Mediastinal and retroesophageal localizations of abnormal parathyroid gland adversely affected the accuracy of the ultrasound. No cervical hematoma was noted. Transient recurrent laryngeal nerve palsy occurred in four patients. Twenty-three patients required postoperative calcium supplementation for 2 to 4 months, and all were normocalcemic at follow-up. Conclusions: Cervical ultrasound is a reliable preoperative exploration allowing parathyroidectomy via unilateral approach under local anesthesia.
Thyroid-Related Factors that Influence Preoperative Localization of Parathyroid Adenomas
Endocrine Practice, 2012
Objective: To evaluate the effect that thyroid-related factors have on the preoperative localization of parathyroid adenomas. Methods: This retrospective study included adult patients who were referred for further evaluation of primary hyperparathyroidism between December 2005 and October 2009 at a teaching and research hospital in Turkey. High-frequency ultrasonography and sestamibi scintigraphy (MIBI) were performed in all patients. Surgical procedure involved focal or bilateral exploration on the basis of concordant or discordant imaging studies. Selection of patients for minimally invasive parathyroidectomy was made based on the presence or absence of a single parathyroid adenoma detected by both ultrasonography and MIBI scan. Patients with negative or discordant imaging studies and a concomitant thyroid nodule underwent bilateral neck exploration. Results: Two hundred and forty-eight patients with primary hyperparathyroidism who underwent parathyroidectomy were included in the study. Parathyroid gland abnormalities were successfully detected preoperatively by ultrasonography in 231 patients and by MIBI scan in 152 patients. When used together, ultrasonography and MIBI scan were unsuccessful in detecting an abnormality in 11 cases. MIBI scan visualized a lesion in 6 cases that remained undiagnosed by ultrasonography. Fifty-six of 85 patients with lesions detected by ultrasonography, but not by MIBI scan, had thyroid nodules. The frequency of thyroid nodules was higher in the 96 patients in whom a MIBI scan could visualize a parathyroid lesion than in the 152 patients in whom MIBI scan was successful (P = .004). No difference was observed regarding ipsilateral thyroid lobe involvement or nodule volume. Parathyroid adenomas were significantly smaller in patients with negative MIBI scans (P<.001). Conclusion: Our results suggest that ultrasonography is more sensitive than MIBI scan in the detection of parathyroid adenomas, particularly in the presence of small parathyroid adenomas or other thyroid related-factors.
Parathyroid Adenoma Localization: Surgeon-Performed Ultrasound Versus Sestamibi
The Laryngoscope, 2006
Objectives: Compare surgeon-performed ultrasound versus sestamibi for preoperative parathyroid adenoma localization. Study Design: Singleinstitutional cohort. Methods: One hundred six consecutive patients undergoing parathyroidectomy at an academic institution between 2004 to 2005 were included. Of those, 103 underwent both surgeonperformed ultrasound and sestamibi-Tc99m localization preoperatively. Primary outcome is sensitivity for adenoma localization to correct quadrant (right vs. left, superior vs. inferior). Results: Hypercalcemia resolved in 97% of patients. Sensitivities for correct quadrant localization for ultrasound versus sestamibi were 87% versus 58% (P < .001). Specificities were 95%. Positive and negative predictive values were 85% versus 78% and 96% versus 87%, respectively. Combined sensitivity was 93%. Sensitivities for correct side localization were 91% and 74% (P ؍ .002). Conclusions: Ultrasound appears more sensitive than sestamibi for localization to correct quadrant or side when performed in-office by the author in this cohort.
Parathyroid scintigraphy and minimal invasive surgery in parathyroid adenomas
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2015
This study aims to identify the diagnostic capacity of the technetium 99m sestamibi scintigraphy with single photon emission computed tomography for localizing parathyroid pathologies. Data of 13 patients (4 males, 9 females; mean age 49.23 years; range 27 to 63 years) who had minimally invasive parathyroidectomy due to primary hyperparathyroidism at the Haseki Training and Research Hospital Ear-Nose-Throat clinic between January 2013 and December 2013 were retrospectively analyzed. Two patients were excluded due to incomplete documentation. Mean preoperative parathyroid hormone and calcium levels were 284.36 (134-1,083 pg/mL) and 11.9 (10.7-13.5 mg/dL), respectively. The operation was deemed adequate if intraoperative parathyroid hormone dropped by 50% from the preoperative level or frozen section analysis showed hypercellular gland or adenoma. Only sestamibi scintigraphy results were consistent with focal exploration findings in all patients. Focal exploration and parathyroid aden...
World Journal of Surgery, 1987
In a previous report we compared intraoperative ultrasound (IOUS) to preoperative ultrasound (US) in 25 consecutive patients undergoing reoperations for primary hyperparathyroidism. We demonstrated the superior effectiveness of IOUS to image abnormal parathyroid glands compared to US, and a 50% reduction in operative time resulting from this superior imaging capability. The present study extends these comparisons of preoperative imaging techniques to include computed tomography (CT) and technetium/thallium scintigraphy (Tc/TI) in an updated series of 39 patients undergoing reoperative parathyroid surgery. All 39 patients underwent successful reoperations for either parathyroid adeuoma (34 patients), parathyroid hyperplasia (4 patients), or parathyroid carcinoma (1 patient). IOUS was more effective than preoperative US, CT scan, or Tc/TI scintigraphy in imaging 41 abnormal glands in these 39 patients. IOUS was not dependent on size or anatomic location of an abnormal gland for successful imaging. Abnormal glands in unusual locations, such as intrathyroidal adenomas or undescended adenomas, were imaged accurately with IOUS. Multiglandular disease was detected by IOUS, with correct imaging of 3 hyperplastic glands in a single patient; no other imaging technique was able to identify more than 1 abnormal gland in any patient. No imaging study (including IOUS restricted to the neck alone) was able to identify accurately a mediastinal parathyroid adenoma (1 patient). A clinical decision analysis revealed that IOUS had the highest sensitivity and positive predictive value of any imaging study. IOUS is thus a tool to be used by the surgeon in reoperations for parathyroid disease to facilitate dissection and identification of abnormal glands. When positive, IOUS can help the surgeon proceed quickly and easily to the location of abnormal tissue. Although most initial operations for primary hyperparathyroidism are successful, up to 10% of patients will require reoperation for persistent or recurrent hyperparathyroidism [1, 2]. Reoperations through fibrotic and anatomically distorted areas of the neck are difficult and can lead to increased rates of complications, particularly recurrent laryngeal nerve injury [3]. Methods to help localize abnormal parathyroid glands prior to reoperation are needed. Techniques like ultrasonography (US), computed tomography (CT), and technetium/thallium scintigraphy (Tc/Tl) have been used and results reported [4, 51. The
Journal of Clinical Ultrasound, 2005
Purpose. Solitary adenoma of the parathyroid is the major cause of primary hyperparathyroidism. Many centers advocate a minimally invasive surgical approach, wherein the surgeon explores only a localized area of the neck according to the preoperative imaging evaluation, and the adenoma is resected without histological sampling from the other parathyroid glands. The aim of this study was to evaluate the ability of high-resolution ultrasonography (US) to localize adenomas preoperatively and thereby aid in patient selection for minimal procedures.
World Journal of Surgery, 1988
A total of 51 patients undergoing neck exploration for primary (n = 29) or secondary (n --22) hyperparathyroidism were studied by 3 localization techniques: high-resolution computed tomography (CT) scanning, ultrasonography (US), and thallium-technetium subtraction scanning (TTS). The accuracy for locating single adenomas was 93% by CT, 88% by US, and 86% by TTS. The sensitivity for each test was 77%, 52%, and 58%, respectively. At surgery, the mean measurement of the long axis of these glands was 20 mm. The accuracy for locating diffusely hyperplastic glands was 37% by CT, 49% by US, and 31% by TTS. The sensitivity was 33%, 50%, and 26%, respectively. The longest axi s averaged 11 mm. No advantage was shown by the use of multiple tests.