The Utility of Intraoperative Bilateral Internal Jugular Venous Sampling with Rapid Parathyroid Hormone Testing

Overview

Journal Ann Surg

Specialty General Surgery

Date 2007 May 25

PMID 17522522

Citations 23

Authors

Fumito Ito

Rebecca Sippel

Julie Lederman

Herbert Chen

Affiliations

Soon will be listed here.

Abstract

Objective: To determine the utility of routine perioperative bilateral internal jugular venous sampling of parathyroid hormone (BIJ PTH) for localization during parathyroid surgery.

Summary Background Data: Venous sampling for PTH is a useful tool for parathyroid localization in patients undergoing reoperative surgery for hyperparathyroidism (HPT). With the development of intraoperative rapid PTH (ioPTH) testing, internal jugular PTH sampling with ioPTH testing to guide operative localization has been shown to be possible in select, difficult cases. However, the value of BIJ PTH for patients with HPT is unclear.

Methods: Between May 2004 and February 2006, 216 consecutive patients underwent neck exploration for HPT by one surgeon. Of these, 168 patients had BIJ PTH. Internal jugular venous blood was drawn from both left and right sides and analyzed for PTH using a rapid PTH assay. BIJ PTH levels were defined as lateralizing if >5% differences were observed between the right and left internal jugular vein samples.

Results: Of the 168 patients, 120 (71.4%) had a single parathyroid adenoma, 15 (8.9%) had double adenoma, and 33 (19.6%) had hyperplasia. The cure rate after parathyroidectomy was 98.2%. There were no complications related to BIJ PTH sampling. Sensitivity and positive predictive value of BIJ PTH for primary hyperparathyroidism were 80% and 71%, respectively. BIJ PTH was diagnostic in 95 cases (62.9%) in primary HPT. BIJ PTH successfully localized an abnormal gland in 26 of 45 (57.8%) in patients with negative sestamibi scanning. BIJ PTH was especially helpful in 18 of 168 (10.7%) cases when intraoperative peripheral parathyroid hormone did not fall by 50% and BIJ PTH successfully localized the hyperfunctioning glands.

Conclusions: In patients with HPT, BIJ PTH is safe and effective, providing additional localization information in the majority of cases. BIJ PTH is particularly useful in the setting of negative sestamibi scanning and in complex multigland disease cases.

Citing Articles

Parathyroid venous sampling for the preoperative localisation of parathyroid adenoma in patients with primary hyperparathyroidism.

Ho J, Kim D, Lee J, Hong N, Kim B, Kim D Sci Rep. 2022; 12(1):7058.

PMID: 35487946 PMC: 9054741. DOI: 10.1038/s41598-022-11238-0.

Management of primary and renal hyperparathyroidism: guidelines from the German Association of Endocrine Surgeons (CAEK).

Weber T, Dotzenrath C, Dralle H, Niederle B, Riss P, Holzer K Langenbecks Arch Surg. 2021; 406(3):571-585.

PMID: 33880642 DOI: 10.1007/s00423-021-02173-1.

Preoperative Localization Studies in Primary Hyperparathyroidism.

Uludag M Sisli Etfal Hastan Tıp Bul. 2021; 53(1):7-15.

PMID: 33536819 PMC: 7847726. DOI: 10.14744/SEMB.2019.78476.

Persistent Elevation of Parathormone Levels after Surgery for Primary Hyperparathyroidism.

Kota S, Kota S, Jammula S, Bhargav P, Sahoo A, Das S Indian J Endocrinol Metab. 2020; 24(4):366-372.

PMID: 33088762 PMC: 7540826. DOI: 10.4103/ijem.IJEM_212_20.

Intraoperative Adjunct Methods for Localization in Primary Hyperparathyroidism.

Aygun N, Uludag M Sisli Etfal Hastan Tıp Bul. 2020; 53(2):84-95.

PMID: 32377064 PMC: 7199831. DOI: 10.14744/SEMB.2019.37542.

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