scholarly journals Evaluation of Wisconsin and CaPTHUS Indices Usefulness for Predicting Monoglandular and Multiglandular Disease in Patients with Primary Hyperparathyroidism through the Analysis of a Single-Center Experience

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Loredana De Pasquale ◽  
Eleonora Lori ◽  
Antonio Mario Bulfamante ◽  
Giovanni Felisati ◽  
Luca Castellani ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Preoperative Imaging ◽  
Multiglandular Disease ◽  
Single Adenoma ◽  
Single Center Experience ◽  
Disease Outcomes ◽  
Main Challenge ◽  
Intraoperative Pth ◽  
Focused Parathyroidectomy ◽  
Parathyroid Localization

Background. The main challenge for treating primary hyperparathyroidism (PHPT) is to understand if it is caused by a single adenoma (80–85% of the cases) or by a multiglandular disease (15–20%), both preoperatively and intraoperatively. For this reason, some preoperative scores were proposed in the literature, to perform focused parathyroidectomy, avoiding intraoperative parathormone assay (ioPTH). The most known are the CaPTHUS test and the Wisconsin index. We applied them to our experience. Methods. A retrospective cohort study on 462 patients referred for parathyroidectomy to Thyroid and Parathyroid Unit at Santi Paolo e Carlo Hospital, Milan, Italy, from 2011 to 2021. Only patients affected with benign PHPT and neck ultrasound performed at our institution were included. Both patients for whom preoperative imaging agreed with the localization of a single diseased parathyroid and those with only ultrasound or scintigraphy positive for parathyroid localization underwent Mini-Invasive Video-assisted parathyroidectomy. In all cases, ioPTH assay was performed. The conversion to bilateral neck exploration was decided based on the drop in ioPTH. CaPTHUS score and the Wisconsin index (Win) were applied to the series. CaPTHUS score ≥3 and Win index >1600, according to the original studies of the literature, were considered at high probability of monoglandular disease. Outcomes in these two groups were examined. Results. 236 patients were eligible for the study. The pathology resulted in multiglandular disease in 24 patients (10.2%). Among these, 18 (75.0%) obtained a CaPTHUS score ≥3, and 20 (83.3%) had a Win index>1600. Intraoperative PTH allowed to identify multiglandular disease in 16 of 18 cases with CaPTHUS ≥3 and in 18 of 20 cases with win >1600, who could have been lost, based only on the results of these 2 tests. Conclusion. Based on our experience, CaPTHUS test and Wisconsin index were not so useful in predicting multiglandular disease as ioPTH.

scholarly journals Contemporary surgical treatment of primary hyperparathyroidism without intraoperative parathyroid hormone measurement

2015 ◽  
Vol 97 (8) ◽  
pp. 603-607 ◽  
Author(s):  
OA Mownah ◽  
G Pafitanis ◽  
WM Drake ◽  
JN Crinnion
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Frozen Section ◽  
Lateral Approach ◽  
Preoperative Imaging ◽  
Surgical Cure ◽  
Focused Parathyroidectomy ◽  
Intraoperative Parathyroid Hormone ◽  
Iopth Measurement

Introduction Primary hyperparathyroidism (pHPT) is usually the result of a single adenoma that can often be accurately located preoperatively and excised by a focused operation. Intraoperative parathyroid hormone (IOPTH) measurement is used occasionally to detect additional abnormal glands. However, it remains controversial as to whether IOPTH monitoring is necessary. This study presents the results of a large series of focused parathyroidectomy without IOPTH measurement. Methods Data from 2003 to 2014 were collected on 180 consecutive patients who underwent surgical treatment for pHPT by a single surgeon. Preoperative ultrasonography and sestamibi imaging was performed routinely, with computed tomography (CT) and/or selective venous sampling in selected cases. The preferred procedure for single gland disease was a focused lateral approach guided by on-table surgeon performed ultrasonography. Frozen section was used selectively and surgical cure was defined as normocalcaemia at the six-month follow-up appointment. Results Focused surgery was undertaken in 146 patients (81%) and 97% of these cases had concordant results with two imaging modalities. In all cases, an abnormal gland was discovered at the predetermined site. Of the 146 patients, 132 underwent a focused lateral approach (11 of which were converted to a collar incision), 10 required a collar incision and 4 underwent a mini-sternotomy. At 6 months following surgery, 142 patients were normocalcaemic (97% primary cure rate). Three of the four treatment failures had subsequent surgery and are now biochemically cured. There were no complications or cases of persistent hypocalcaemia. Conclusions This study provides further evidence that in the presence of concordant preoperative imaging, IOPTH measurement can be safely omitted when performing focused parathyroidectomy for most cases of pHPT.

Use of Preoperative Imaging in Primary Hyperparathyroidism

2020 ◽  
Vol 106 (1) ◽  
pp. e328-e337
Author(s):  
David T Broome ◽  
Robert Naples ◽  
Richard Bailey ◽  
Zehra Tekin ◽  
Moska Hamidi ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Ct Scan ◽  
Predictive Value ◽  
Imaging Modalities ◽  
Preoperative Imaging ◽  
Multiglandular Disease ◽  
Cure Rate ◽  
4D Ct ◽  
Operative Findings ◽  
Double Adenomas

Abstract Context Preoperative imaging is performed routinely to guide surgical management in primary hyperparathyroidism, but the optimal imaging modalities are debated. Objective Our objectives were to evaluate which imaging modalities are associated with improved cure rate and higher concordance rates with intraoperative findings. A secondary aim was to determine whether additive imaging is associated with higher cure rate. Design, Setting, and Patients This is a retrospective cohort review of 1485 adult patients during a 14-year period (2004-2017) at an academic tertiary referral center that presented for initial parathyroidectomy for de novo primary hyperparathyroidism. Main Outcome Measures Surgical cure rate, concordance of imaging with operative findings, and imaging performance. Results The overall cure rate was 94.1% (95% confidence interval, 0.93-0.95). Cure rate was significantly improved if sestamibi/single-photon emission computed tomography (SPECT) was concordant with operative findings (95.9% vs. 92.5%, P = 0.010). Adding a third imaging modality did not improve cure rate (1 imaging type 91.8% vs. 2 imaging types 94.4% vs. 3 imaging types 87.2%, P = 0.59). Despite having a low number of cases (n = 28), 4-dimensional (4D) CT scan outperformed (higher sensitivity, specificity, positive predictive value, negative predictive value) all imaging modalities in multiglandular disease and double adenomas, and sestamibi/SPECT in single adenomas. Conclusions Preoperative ultrasound combined with sestamibi/SPECT were associated with the highest cure and concordance rates. If pathology was not found on ultrasound and sestamibi/SPECT, additional imaging did not improve the cure rate or concordance. 4D CT scan outperformed all imaging modalities in multiglandular disease and double adenomas, and sestamibi/SPECT in single adenomas, but these findings were underpowered.

scholarly journals 99mTechnetium Sestamibi-123Iodine Scintigraphy Is More Accurate Than 99mTechnetium Sestamibi Alone before Surgery for Primary Hyperparathyroidism

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Eeva M. Ryhänen ◽  
Jukka Schildt ◽  
Ilkka Heiskanen ◽  
Mika Väisänen ◽  
Aapo Ahonen ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Multiglandular Disease ◽  
Single Adenoma ◽  
Histological Findings ◽  
Cure Rate ◽  
Single Centre ◽  
Primary Surgery ◽  
Outcome Of Surgery ◽  
Dual Tracer

Objectives. Studies comparing outcome of single-T99mc-methoxyisobutylisonitrile (T99mc-sestamibi) and dual-tracer T99mc-sestamibi scintigraphy in combination with 123I before primary surgery of primary hyperparathyroidism (PHPT) are scarce. Methods. We compared T99mc-sestamibi/123I and T99mc-sestamibi in a single-centre retrospective series of 269 PHPT patients. The results were related to laboratory, surgical and histological findings. Results. T99mc-sestamibi/123I and T99mc-sestamibi were positive in 206 (76.6%) and 111 (41.3%) of 269 patients, respectively (P < 0.001). Accuracies for T99mc-sestamibi/123I and T99mc-sestamibi were 63.4% and 34.9%, respectively (96% CI, P < 0.001). Prevalence of multiglandular disease was 15.2%. In multiglandular disease, T99mc-sestamibi/123I and T99mc-sestamibi revealed 43.8 and 22.1% of pathological glands, respectively (P < 0.001). Cure rate was similar for patients with (191/206; 92.7%) and without (59 of 63; 93.7%) a positive T99mc-sestamibi/123I finding. Duration of targeted surgery (one or two quadrants) was 21 and 15 minutes shorter than bilateral neck exploration, respectively (both P < 0.001). Higher serum calcium (P = 0.014) and PTH (P = 0.055) concentrations and larger tumours (P < 0.001) characterized the 206 patients with a positive preoperative scan who were cured by removal of a single adenoma. Conclusions. T99mc-sestamibi/123I scintigraphy is more accurate than T99mc-sestamibi before surgery of PHPT. However, outcome of surgery is not determined by scintigraphy alone.

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

2014 ◽  
Vol 170 (5) ◽  
pp. 719-725 ◽  
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.

A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003

2005 ◽  
Vol 132 (3) ◽  
pp. 359-372 ◽  
Author(s):  
James M. Ruda ◽  
Christopher S. Hollenbeak ◽  
Brendan C. Stack
Keyword(s):  
Primary Hyperparathyroidism ◽  
Bilateral Neck Exploration ◽  
Neck Exploration ◽  
Preoperative Imaging ◽  
Intraoperative Pth ◽  
Multiple Gland Disease ◽  
Preoperative Diagnostic ◽  
Diagnostic Modalities ◽  
Surgical Treatments ◽  
Double Adenomas

OBJECTIVE: To systematically review the current preoperative diagnostic modalities, surgical treatments, and glandular pathologies associated with primary hyperparathyroidism. STUDY DESIGN: A systematic literature review. RESULTS: Of the 20,225 cases of primary hyperpara-thyroidism reported, solitary adenomas (SA), multiple gland hyperplasia disease (MGHD), double adenomas (DA), and parathyroid carcinomas (CAR) occurred in 88.90%, 5.74%, 4.14%, and 0.74% of cases respectively. Tc99m-sestamibi and ultrasound were 88.44% and 78.55% sensitive, respectively, for SA, 44.46% and 34.86% for MGHD, and 29.95% and 16.20% for DA, respectively. Postoperative normocalcemia was achieved in 96.66%, 95.25%, and 97.69% of patients offered minimally invasive radio-guided parathyroidectomy (MIRP), unilateral, and bilateral neck exploration (BNE). Intraoperative PTH assays (IOPTH) were helpful in approximately 60% of bilateral neck exploration conversion (BNEC) surgeries. CONCLUSION: The overall prevalence of multiple gland disease (MGD and DA) was lower than often suggested by conventional wisdom. Furthermore, preoperative imaging was less accurate than it is often perceived for accurately imaging MGD. MIRP and UNE were more successful in achieving normo-calcemia than is typically quoted. IOPTH was a helpful but not “fool-proof” adjunct in parathyroid exploration surgery. SIGNIFICANCE: These results support a greater role for the treatment of primary hyperparathyroidism using less invasive approaches. EMB rating: B-3.

scholarly journals Surgery for Primary Hyperparathyroidism in Patients with Preoperatively Negative Sestamibi Scan and Discordant Imaging Studies: The Usefulness of Intraoperative Parathyroid Hormone Monitoring

2013 ◽  
Vol 6 ◽  
pp. CMED.S13114 ◽  
Author(s):  
Pietro Giorgio Caló ◽  
Giuseppe Pisano ◽  
Giulia Loi ◽  
Fabio Medas ◽  
Alberto Tatti ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Preoperative Imaging ◽  
Imaging Studies ◽  
Parathyroid Hormone Monitoring ◽  
Intraoperative Pth ◽  
Group A ◽  
Group B ◽  
Intraoperative Parathyroid Hormone ◽  
The Impact

The aim of this study was to evaluate the impact of intraoperative parathyroid hormone (PTH) monitoring on surgical strategy, intraoperative findings, and outcome in patients with negative sestamibi scintigraphy and with discordant imaging studies. We divided our 175 patients into 3 groups: group A was methoxyisobutylisonitrile (MIBI)-positive and ultrasonography positive and was concordant (114 patients), group B was MIBI-positive and ultrasonography-negative (50 patients), and group C was MIBI–-and ultrasonography-negative (11 patients). The overall operative success was 99.12% in group A, 98% in group B, and 90.91% in group C, with an incidence of multiglandular disease of 3.5% in group A, 12% in group B, and 9.09% in group C. Intraoperative PTH monitoring changed the operative management in 2.63% of patients in group A and 14% in group B. The use of intraoperative PTH achieves to obtain excellent results in the treatment of primary hyperparathyroidism in high-volume centers, even in the most difficult cases, during MIBI-negative and discordant preoperative imaging studies.

Preoperative Imaging for Parathyroid Localization in Primary Hyperparathyroidism

1997 ◽  
Vol 4 (4) ◽  
pp. 338-342 ◽  
Author(s):  
Yusaku Okada ◽  
Youichi Mizutani ◽  
Hideo Takeuchi ◽  
Chohei Shigeno ◽  
Junji Konishi ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Preoperative Imaging ◽  
Parathyroid Localization
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