Stepwise Approach for Parathyroid Localisation in Primary Hyperparathyroidism

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2019 Nov 13

PMID 31712842

Citations 10

Authors

Vijay Korwar

Fernando Yuen Chang

Ella Teasdale

Ivo Suchett-Kaye

Anusha Edwards

Justin Morgan

Affiliations

Soon will be listed here.

Abstract

Introduction: Primary hyperparathyroidism (PHPT) is a relatively common condition in surgical practice. Availability of localisation studies has shifted the treatment from bilateral neck exploration to selective parathyroidectomy. Several imaging modalities, each with varying sensitivities, are available to detect abnormal parathyroid glands. Ultrasound is almost universally accepted as the first line radiological investigation however its sensitivity is particularly heterogeneous and operator-dependent.

Material And Methods: We studied 250 consecutive patients with PHPT who underwent parathyroidectomy in our hospital over a period of 33 months. Pre-operative neck ultrasound, 99mTc-sestamibi and single-photon emission computed tomography (SPECT CT) were performed in 249, 237 and 198 patients respectively. Unilateral and bilateral neck exploration was performed in 190 and 60 patients, respectively. Sensitivity, positive predictive value (PPV) and accuracy were calculated comparing the results with surgical and pathology findings.

Results: Mean pre and postoperative PTH and adjusted calcium were, 11 ± 10.6 pmol/L, 1.9 ± 3.6, 2.81 ± 0.2 and 2.45 ± 0.2 mmol/L. There were 71 (29.95%) discordant results between US, compared to sestamibi and SPECT CT. An average of 1.9 parathyroid glands were removed with a mean weight of 0.92 g. Overall success rate based on postoperative PTH levels was 94.8%. Overall sensitivity, PPV and accuracy for US were 80.80%, 92.35%, and 75.73% respectively; for sestamibi were 71.82%, 94.61%, 69.00% and for SPECT CT were; 70.21%, 97.78%, 69.11% respectively.

Conclusion: Ultrasound performed by an experienced specialist sonographer is highly sensitive in localising abnormal parathyroid glands. It can be used as a main and sole investigation in the majority of patients. Sestamibi, SPECT CT and other investigations should be performed in a step-wise manner and reserved for patients with negative US, failed primary procedure and recurrences.

Citing Articles

Utility of 99mTc-Sestamibi Single-Photon Emission Computed Tomography (SPECT)/CT Single Imaging Strategy in the Preoperative Localization of Parathyroid Adenoma.

Vasandani N Cureus. 2024; 16(1):e51828.

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Differentiating pathologic parathyroid glands from thyroid nodules on neck ultrasound: the PARATH-US cross-sectional study.

Yazgi D, Richa C, Salenave S, Kamenicky P, Bourouina A, Clavier L Lancet Reg Health Eur. 2023; 35:100751.

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Primary Hyperparathyroidism: Outcomes of Repeated Imaging After Initial Negative Radiological Localization.

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Can we skip technetium-99 m sestamibi scintigraphy in pediatric primary hyperparathyroidism patients with positive neck ultrasound results?.

He Y, Luo Y, Jin S, Wang O, Liao Q, Zhu Q Pediatr Radiol. 2023; 53(11):2253-2259.

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The Dark Side of Ultrasound Imaging in Parathyroid Disease.

Centello R, Sesti F, Feola T, Sada V, Pandozzi C, Di Serafino M J Clin Med. 2023; 12(7).

PMID: 37048571 PMC: 10095081. DOI: 10.3390/jcm12072487.

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