Parathyroid adenoma imaging-preoperative localization

Open access

ABSTRACT

Primary 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 evaluation included imaging explorations (ultrasonography, scintigraphy and cervical CT scan) and therapeutic success was confirmed by histopathological result and the evolution of hormonal and biochemical tests.

Intraoperative exploration revealed a single adenoma in 59 patients and one double adenoma.

Thyroid disease was associated in 27 (45%) patients

1. Yip, L., Silverberg, S.J. & El-Hajj Fuleihan, G. (2015, July). Preoperative localization for parathyroid surgery in patients with primary hyperparathyroidism. Retrieved July 2015, from http://www.uptodate.com/contents/preoperativelocalization-for-parathyroid-surgery-in-patientswith-primary-hyperparathyroidism?source=search_result&search=preoperative+localization+for+parathyroid+surgery&selectedTitle=1~150

2. Pietro, G.C., Giuseppe, P. & Giulia, L. (2013). Surgery for Primary Hyperparathyroidsm in Patients with Preoperatively Negative Sestamibi Scan and Discordant Imaging Studies: The Usefulness of Intraoperative Parathyroid Hormone Monitoring. Libertas Academica. Clinical Medicine Insights: Endocrinology and Diabetes. (6), 63-67; DOI: 10.4137/CMED. S13114.

3. Tibbli, S., Bonderson, A.G. & Ljunberg, O. (1982). Unilateral parathyroidectomy in hyperparathyroidism due to single adenoma. Ann Surg. 195, 245-52; DOI: 10.1097/00000658-198203000-00001;

4. Wang, T. S., Cheung, K., Farrokhyar, F., Roman, S. A., & Sosa, J. A. (2013). A meta-analysis of the effect of prophylactic central compartment neck dissection on locoregional recurrence rates in patients with papillary thyroid cancer. Ann Surg Oncol, 20(11), 3477-3483. doi: 10.1245/ s10434-013-3125-0

5. Mihai, R., Simon, D. & Hellman, P. (2009). Imaging for primary hyperparathyroidism-an evidence-based analysis. Langenbecks Arch Surg .394(5), 765-784. doi: 10.1007/s00423-009-0534-4

6. Bonnie, F. (2013,Oct). Imaging in primary hyperparathyroidism. Retrieved July 2015, from http://emedicine.medscape.com/article/390728-overview#a22

7. Berber, E., Parikh, R. T., Ballem, N., Garner, C. N., Milas, M., & Siperstein, A. E. (2008). Factors contributing to negative parathyroid localization: an analysis of 1000 patients. Surgery, 144(1), 74-79. doi: 10.1016/j.surg.2008.03.019

8. Nathan, A.J, Mitchell, E.T. & Ogilvie, J.B. (2007). Parathyroid Imaging: Technique and Role in the Preoperative Evaluation of Primary Hyperparathyroidism. AJR. 188, 1706-1715;

9. Boi, F., Lombardo, C., Cocco, M. C., Piga, M., Serra, A., Lai, M. L., Calo P.G., Nicolosi, A. & Mariotti, S. (2013). Thyroid diseases cause mismatch between MIBI scan and neck ultrasound in the diagnosis of hyperfunctioning parathyroids: usefulness of FNA-PTH assay. Eur J Endocrinol, 168(1), 49-58. doi: 10.1530/eje-12-0742

10. Mihai, R., Gleeson, F., Buley, I.D., Roskell, D.E. & Sadler, G.P. (2006). Negative imaging studies for primary hyperparathyroidism are unavoidable: correlation of sestamibi and highresolution ultrasound scanning with histological analysis in 150 patients. World J Surg. 30(5), 697-704. DOI: 10.1007/s00268-005-0338-9.

11. Lal, A. & Chen, H. (2007). The negative sestamibi scan: is a minimally invasive parathyroidectomy still possible? Ann Surg Oncol .(14),2363;

12. Chiu, B., Sturgeon, C. &Angelos, P. (2006). What is the link between nonlocalizing sestamibi scans, multigland disease, and persistent hypercalcemia? A study of 401 consecutive patients undergoing parathyroidectomy. Surgery. 140(3), 418-422. DOI:10.1245/s10434-007-9451-3.

13. Ministerul Sanatatii. (2010). Ghid pentru diagnosticul si tratamentul hiperparatiroidismului primar. Retrieved 2015, from http://www.ms.ro/index.php?pag=181&pg=4

14. Tarcoveanu, E., Niculescu, D., Moldoveanu, R. & Zbranca, E. (2009).Tratamentul chirurgical al hiperparatiroidismului. Chirurgia. 104 (5), 531-544;

15. Weber, T., Maier-Funk, C., Ohlhauser, D., Hillenbrand, A., Cammerer, G., Barth, T. F., Henne-Burns, D., Boehm B.O., Reske, S.N. & Luster, M. (2013). Accurate preoperative localization of parathyroid adenomas with C-11 methionine PET/CT. Ann Surg, 257(6), 1124-1128. doi: 10.1097/SLA.0b013e318289b345

16. Wakamatsu, H., Noguchi, S., Yamashita, H., Yamashita, H., Tamura, S., Jinnouchi, S., Nagamachi, S. & Futami, S. (2003). Parathyroid scintigraphy with 99mTc-MIBI and 123I subtraction: a comparison with magnetic resonance imaging and ultrasonography. Nucl Med Commun, 24(7), 755-762. doi: 10.1097/01. mnm.0000080246.50447.7d

17. Lopez Hänninen, E., Vogl, T.J., Steinmüller, T., Ricke, J., Neuhaus, P. & Felix, R. (2000). Preoperative contrast-enhanced MRI of the parathyroid glands in hyperparathyroidism. Invest Radiol 35(7), 426-430.

18. Powell, A.C., Alexander, H.R., Chang, R., Marx, S.J., Skarulis, M., Pingpank, J.F., Bartlett, D.L., Hughes, M., Weinstein, L.S., Simonds, W.F., Collins, M.F., Shawker, T., Chen ,C.C., Reynolds, J., Cochran, C., Steinberg, S.M. & Libutti, S.K. (2009). Reoperation for parathyroid adenoma: a contemporary experience. Surgery. 146(6), 1144-55. DOI: 10.1016/j.surg.2009.09.015.

ARS Medica Tomitana

The Journal of "Ovidius" University of Constanta

Journal Information

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 588 491 58
PDF Downloads 550 514 69