Predictors of adenoma size and location in primary hyperparathyroidism

Abstract Purpose In primary hyperparathyroidism (PHPT), intraoperative localization of the parathyroid adenoma can be challenging, especially in cases of negative preoperative imaging. Since a focused unilateral parathyroidectomy has benefits compared to a conventional bilateral neck exploration, the question arises whether adenoma size prediction can facilitate a targeted approach. We investigated whether single parathyroid adenoma size can be estimated using preoperative parathyroid hormone (PTH), calcium, and phosphate in patients with PHPT. Preoperative imaging accuracy was evaluated. Methods The data of 156 patients who underwent curative parathyroidectomy for single adenoma PHPT were analyzed retrospectively. Information obtained included laboratory data, imaging results, intraoperative data, and final pathology. Imaging accuracy was analyzed descriptively. The association between preoperative biochemical markers and adenoma dimensions was investigated using Spearman’s correlation coefficient and multivariable regression modeling. Results Cervical ultrasound correctly predicted adenoma laterality in 95.5%, sestamibi scintigraphy in 80.6%, both had lower true-positive rates for quadrant prediction. Patients with negative imaging results showed higher thyroid volumes than those with positive results. Adenoma volume was positively correlated with preoperative PTH (p < 0.001) and calcium (p < 0.001) and negatively correlated with preoperative phosphate (p = 0.001). Using these preoperative biochemical markers and patient age and BMI, adenoma volume can be significantly predicted using the multivariable regression algorithm. Conclusion Cervical ultrasound is superior to scintigraphy for predicting adenoma location and should be the first-choice imaging method, but both methods may be limited by increased thyroid volume. Large adenomas are more likely with higher PTH, higher calcium, and lower phosphate levels. In cases of undetermined adenoma location, an estimation of adenoma volume via our algorithm could corroborate sonographic volume measurements of the suspected adenoma.

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11C-Choline PET/CT vs. 99mTc-MIBI/123Iodide Subtraction SPECT/CT for Preoperative Detection of Abnormal Parathyroid Glands in Primary Hyperparathyroidism: A Prospective, Single-Centre Clinical Trial in 60 Patients

Diagnostics ◽

10.3390/diagnostics10110975 ◽

2020 ◽

Vol 10 (11) ◽

pp. 975

Author(s):

Afefah Ismail ◽

Julie Wulf Christensen ◽

Martin Krakauer ◽

Susanne Bonnichsen Søndergaard ◽

Bo Zerahn ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Method Comparison ◽

Preoperative Imaging ◽

P Value ◽

Imaging Method ◽

Dual Isotope ◽

Choline Pet ◽

First Choice ◽

Pet Ct ◽

99Mtc Mibi

Background: In patients with primary hyperparathyroidism (PHPT) locating hyperfunctioning glands (HPGs) is crucial when planning minimally invasive surgery. Dual-isotope subtraction scintigraphy with 99mTc-MIBI/123Iodide using SPECT/CT and planar pinhole imaging (Method A) has previously shown a sensitivity >93%. However, the method is costly and time consuming and entails a high radiation dose. 11C-Choline PET/CT (Method B) is an appealing candidate method unencumbered by these disadvantages. Methods: Sixty patients with newly diagnosed PHPT participated and were scanned using both methods prior to parathyroidectomy. We investigated whether sensitivities of Method A and Method B are similar in a method-to-method comparison when using surgical findings as the true location. Results: At the patient level, sensitivities were (A) 0.98 (95% CI: 0.90–1.00) and (B) 1.00 (95% CI: 0.93–1.00). At the gland level, sensitivities were (A) 0.88 (95% CI: 0.78–0.94) and (B) 0.87 (95% CI: 0.76–0.92). With a non-inferiority margin of ∆ = −0.1, we found a 1-sided p-value < 0.001. Conclusion: Our methods comparison study found that sensitivity of Method B was not inferior to Method A. We suggest that 11C-Choline PET/CT is a clinically relevant first-choice candidate for preoperative imaging of PHPT and that Method B can likely replace Method A in the near future.

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SAT-LB65 A Rare Existence

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1998 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Jiselle Aimee Yaplito Bedia ◽

Maria Honolina S Gomez

Keyword(s):

Primary Hyperparathyroidism ◽

Parathyroid Adenoma ◽

Clinical Presentation ◽

Renal Involvement ◽

Preoperative Imaging ◽

Biochemical Screening ◽

Central Target ◽

Target Organs ◽

Postoperative Hypoparathyroidism ◽

Parathyroid Adenomas

Abstract Primary hyperparathyroidism is a common endocrine disorder of metabolism usually due to a parathyroid adenoma. Although, the clinical presentation of primary hyperparathyroidism has changed from Albright’s description of a disease of bones and stones, the central target organs affected by this disorder continue to be the skeleton and kidneys. With the advent of routine biochemical screening, the typical diagnosis of primary hyperparathyroidism is no longer accompanied by overt skeletal and renal involvement. Majority of the cases of primary hyperparathyroidism are due to parathyroid adenomas. Giant glands were defined as greater than the 95th percentile, characterized as glands weighing > 3.5 grams. This present case in a 54-year old female is a rare case of primary hyperparathyroidism secondary to a giant parathyroid adenoma measuring 10.7 x 8.0 x 40.0 cm and weighing 145 grams, the largest giant parathyroid adenoma reported to date, with co-existent silent thymoma, multinodular goiter and osteosclerosis of the vertebral spine, metaphorically known as the “rugger-jersey spine”. The association between thymoma and parathyroid adenoma is rare, and only 3 cases have been reported in the literature. We characterized the correlation of preoperative imaging, intraoperative location, and postoperative course, including significant postoperative hypoparathyroidism, as compared to other patients with PHPT to determine whether giant adenomas represent a clinical entity with distinct clinical characteristics. Keywords: primary hyperparathyroidism, giant parathyroid adenoma, rugger-jersey spine, thymoma Abbreviation PHPT Primary hyperparathyroidism

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Single Center Experience in the Surgical Management of Primary Hyperparathyroidism

Clinical and Experimental Otorhinolaryngology ◽

10.21053/ceo.2019.01361 ◽

2020 ◽

Vol 13 (3) ◽

pp. 285-290

Author(s):

Berat Demir ◽

Adem Binnetoglu ◽

Akın Sahin ◽

Dilek Gogas Yavuz

Keyword(s):

Computed Tomography ◽

Primary Hyperparathyroidism ◽

Parathyroid Adenoma ◽

Imaging Modalities ◽

Neck Exploration ◽

Preoperative Imaging ◽

Emission Computed Tomography ◽

Laboratory Values ◽

Ectopic Parathyroid ◽

Pathology Reports

Objectives. As calcium included as a part of routine laboratory screening early diagnosis of primary hyperparathyroidism (PHPT) has been increased. Surgical resection of parathyroid adenoma or hyperplasia still is the mainstay of the treatment for most PHPT patients. The aim of this study was to evaluate of the surgical outcomes of patients with PHPT that referred to our ENT department of our University Hospital for the last 6 years.Methods. One hundred thirty-seven patients with PHPT who underwent parathyroid surgery in our clinic between October 2011 and January 2018 included in this retrospective study. Data on demographics, clinical findings, past medical history, preoperative laboratory values in 3 months, preoperative localizing imaging studies including ultrasonography (USG) and 99mTc-sestamibi (methoxyisobutyl isonitrile, [MIBI]) scan, operative findings, postoperative laboratory values, and pathology reports were recorded. MIBI scan and USG are used as the first-line modalities in our center. Single-photon emission computed tomography was used for challenging situations of re-exploration and ectopic parathyroid pathology. Four-dimensional computed tomography scanning is was preferred as the last imaging modality. Focused unilateral neck exploration (FUNE) was performed with intraoperative frozen section analysis as a routine procedure. Bilateral neck exploration (BNE) was used only in re-exploration, ectopic parathyroid, and with high suspicion of multigland disease.Results. Totally 137 patients (female:male, 3:3; mean age, 54.6±13.2 years) included in the study. Single parathyroid adenoma was found in 108 patients (78.8%). Most common adenoma localization was left inferior parathyroid gland (46.7%). FUNE was performed in 89.8% of the patients and BNE for 10.2% of the patients. Postoperative normocalcemia was reached in 132 patients and permanent hypocalcemia was observed in two patients. Persistence hypercalcemia observed in three patients. Postoperative pathology reports revealed three patients have parathyroid carcinoma.Conclusion. Preoperative imaging modalities is very important in parathyroidectomy surgery. Routine use of preoperative imaging modalities reduced the risk of complications in our clinic.

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Full wave 3D inverse scattering transmission ultrasound tomography in the presence of high contrast

Scientific Reports ◽

10.1038/s41598-020-76754-3 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

James Wiskin ◽

Bilal Malik ◽

David Borup ◽

Nasser Pirshafiey ◽

John Klock

Keyword(s):

High Resolution ◽

Breast Imaging ◽

Quantitative Imaging ◽

Laboratory Data ◽

Real Data ◽

Imaging Method ◽

High Contrast ◽

High Impedance ◽

Imaging Results ◽

Cartilage Disease

AbstractWe present here a quantitative ultrasound tomographic method yielding a sub-mm resolution, quantitative 3D representation of tissue characteristics in the presence of high contrast media. This result is a generalization of previous work where high impedance contrast was not present and may provide a clinically and laboratory relevant, relatively inexpensive, high resolution imaging method for imaging in the presence of bone. This allows tumor, muscle, tendon, ligament or cartilage disease monitoring for therapy and general laboratory or clinical settings. The method has proven useful in breast imaging and is generalized here to high-resolution quantitative imaging in the presence of bone. The laboratory data are acquired in ~ 12 min and the reconstruction in ~ 24 min—approximately 200 times faster than previously reported simulations in the literature. Such fast reconstructions with real data require careful calibration, adequate data redundancy from a 2D array of 2048 elements and a paraxial approximation. The imaging results show that tissue surrounding the high impedance region is artifact free and has correct speed of sound at sub-mm resolution.

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Bilateral neck exploration in patients with primary hyperparathyroidism and discordant imaging results: a single-centre study

Acta Endocrinologica ◽

10.1530/eje-13-0796 ◽

2014 ◽

Vol 170 (5) ◽

pp. 719-725 ◽

Cited By ~ 16

Author(s):

Melanie Philippon ◽

Carole Guerin ◽

David Taieb ◽

Josiane Vaillant ◽

Isabelle Morange ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Imaging Techniques ◽

Preoperative Imaging ◽

Imaging Results ◽

Number Of Patients ◽

Single Centre Study ◽

Correct Location ◽

Cervical Exploration ◽

Focused Parathyroidectomy ◽

Subtraction Scintigraphy

IntroductionFocused parathyroidectomy is the treatment of choice for patients with concordant positive imaging. Bilateral cervical exploration is performed for cases with discordant imaging, yet more than 70% of those cases are the result of a single-gland disease. As focused parathyroidectomy is generally costless and harmless, for cases with discordant imaging, we tried to determine whether preoperative characteristics can lead to a diagnosis of single-gland disease.MethodsThis study included 182 patients treated for primary hyperparathyroidism by bilateral exploration from 2009 to 2012 at La Timone Hospital, Marseille, France. We classified patients based on preoperative images and pathological results (single-gland or multiglandular disease). We then compared the demographical, laboratory and imaging results. We also asked a senior nuclear medicine practitioner who was blind to the ultrasound and pathological results to perform a second reading.ResultsOf the total number of patients, 15.4% had negative, 54.4% discordant and 30.2% concordant imaging. After reviewing the scintigraphy results, 8% of the cases with discordant imaging would have been classified as concordant with ultrasound. Subtraction scintigraphy obtained better results than dual-phase scintigraphy (concordance with ultrasound in 50 vs 31% with classical scintigraphy). For the cases of discordant imaging, no predictive factors of single-gland disease could be identified. Ultrasound and scintigraphy were similarly effective in determining the correct location of the abnormal gland.ConclusionDiscordant results of preoperative imaging modalities do not discriminate between uniglandular and multiglandular diseases in hyperparathyroidism. Diagnostic differentiation between the different causes of hyperparathyroidism requires improvements in imaging techniques and might benefit from subtraction scintigraphy.

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Diagnostic Value of Choline PET in the Preoperative Localization of Hyperfunctioning Parathyroid Gland(s): A Comprehensive Overview

Biomedicines ◽

10.3390/biomedicines9030231 ◽

2021 ◽

Vol 9 (3) ◽

pp. 231

Author(s):

Cristina Ferrari ◽

Giulia Santo ◽

Paolo Mammucci ◽

Antonio Rosario Pisani ◽

Angela Sardaro ◽

...

Keyword(s):

Computed Tomography ◽

Parathyroid Gland ◽

Laboratory Data ◽

Parathyroid Glands ◽

Preoperative Imaging ◽

Emission Computed Tomography ◽

Choline Uptake ◽

Comprehensive Overview ◽

Choline Pet ◽

Imaging Results

Hyperparathyroidism is a metabolic disorder characterized by the excessive production of the parathyroid hormone. The diagnosis is based on clinical and laboratory data. In most cases the only treatment is surgery and a correct preoperatory localization of the hyperfunctioning parathyroid gland(s) is essential. Currently, ultrasonography combined with [99mTc]Tc-MIBI parathyroid scintigraphy, optionally associated with single photon emission computed tomography/computed tomography (SPECT/CT), represent the standard preoperative imaging. In recent years, a number of studies have evaluated the potential role of choline positron emission tomography (PET) in hyperparathyroidism with promising results. Most of the recent evidence underlined its higher sensitivity and diagnostic accuracy in the localization of hyperfunctioning parathyroid glands. Choline PET has a higher spatial resolution that is useful for the detection of smaller parathyroid glands and it also has shorter examination times and favorable radiation exposure. These are just a few of the aspects that support it to overcome traditional imaging. Moreover, from the preliminary data, the choline uptake mechanism seems to also have an impact on its better performance. For these reasons, if first used as second level imaging in patients with negative or inconclusive traditional imaging results, several authors have supported its use as a first line investigation. This comprehensive overview aims to provide an accurate description of the preliminary results available in the literature about the use of choline PET/CT in hyperparathyroidism and to compare these results with the performance of traditional imaging methods.

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