Pre-Operative Localisation of Parathyroid Tumours Using Neck Vein Catheterisation and Radioimmunoassay for Parathyroid Hormone: The Glasgow Experience

Reliable pre-operative localisation of parathyroid tumours can be of value in surgery for primary hyperparathyroidism, and particularly so where re-exploration of the neck is required. Neck vein catheterisation and parathyroid hormone radioimmunoassay have been suggested as a sensitive means of tumour localisation, and we report our experience of the technique over the last five years. A total of 46 patients with primary hyperparathyroidism had 50 studies performed with positive localisation and a pre-operative prediction made on 38 occasions (76%). Forty-two operations were carried out and a parathyroid tumour confirmed in 39 cases for a localisation efficiency of 69 per cent. No negative neck exploration followed a positive localisation. Twelve studies were performed in patients with renal osteodystrophy and localisation to a single site was achieved on only three occasions. It is concluded that neck vein catheterisation and parathyroid hormone assay can correctly localise parathyroid tumours in most cases of primary hyperparathyroidism, but is is suggested that its use be restricted to selected cases such as those subjects with previous negative neck exploration or patients for whom prolonged or repeated surgery may be a particular hazard.

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Ultrasonography alone can reliably locate parathyroid tumours and facilitates minimally invasive parathyroidectomy

Annals of The Royal College of Surgeons of England ◽

10.1308/003588415x14181254790202 ◽

2015 ◽

Vol 97 (6) ◽

pp. 420-424 ◽

Cited By ~ 9

Author(s):

HZ Butt ◽

MA Husainy ◽

A Bolia ◽

NJM London

Keyword(s):

Parathyroid Hormone ◽

Minimally Invasive ◽

Minimally Invasive Parathyroidectomy ◽

Invasive Parathyroidectomy ◽

Preoperative Marking ◽

Multiple Imaging ◽

Parathyroid Tumour ◽

Parathyroid Hormone Assay ◽

Parathyroid Tumours ◽

Intraoperative Parathyroid Hormone

Introduction Minimally invasive parathyroidectomy (MIP) is performed via a short incision (≤3cm). Previous studies have employed multiple imaging modalities including ultrasonography, sestamibi imaging and/or intraoperative parathyroid hormone assay. We present our eight-year experience of MIP using ultrasonography alone. Methods One hundred parathyroidectomies performed by a single surgeon between April 2004 and December 2012 were identified in a prospectively maintained database. All patients underwent ultrasonography including preoperative marking of the lesion by a single radiologist. No other localising diagnostic tests were performed. Results Of the 100 patients (69% female) who underwent parathyroidectomy, 93 had MIP. The median age of all cases was 58 years (range: 19–90 years). All patients exhibited an elevated parathyroid hormone level (median: 19pmol) in the presence of hypercalcaemia (median: 2.86mmol/l, range: 2.54–3.94mmol/l). Conventional surgery was indicated in seven patients owing to the need for concurrent thyroidectomy. The median operative time was 30 minutes (range: 10–130 minutes). Ultrasonography localised parathyroid tumour position correctly in 98% of patients who underwent MIP, and in 97% across both MIP and non-MIP groups. Postoperative complications requiring treatment included pancreatitis and symptomatic hypocalcaemia. Follow-up review at 6–8 weeks demonstrated that 86% of open cases (6/7) and 94% of MIP cases (87/93) were rendered normocalcaemic. Conclusions Our study is the first to demonstrate that the sole use of ultrasonography including preoperative marking can localise parathyroid tumours correctly in 98% of cases suitable for MIP.

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The Localisation of Parathyroid Tumours—A Comparison of Computed Tomography with Cervical Vein Hormone Assay

Scottish Medical Journal ◽

10.1177/003693308302800211 ◽

1983 ◽

Vol 28 (2) ◽

pp. 153-156 ◽

Cited By ~ 4

Author(s):

N. C. McMillan ◽

Linda Smith ◽

N. J. McKellar ◽

G. H. Beastall ◽

I. Fogelman ◽

...

Keyword(s):

Computed Tomography ◽

Parathyroid Hormone ◽

Primary Hyperparathyroidism ◽

Parathyroid Tissue ◽

Venous Catheter ◽

Parathyroid Surgery ◽

Parathyroid Hormone Assay ◽

Parathyroid Tumours ◽

Hormone Assay

Computed tomography has been employed for the localisation of parathyroid tissue in 26 patients with primary hyperparathyroidism. In 14 of these selective venous catheter studies with parathyroid hormone assay were also undertaken. Computed tomography proved unreliable, identifying only 39 per cent whereas the cervical venous hormone assay studies localised 69 per cent of lesions correctly—a figure which is in agreement with several other groups. On balance our results suggest that neither technique should be routinely employed pre-operatively but that, following unsuccessful parathyroid surgery, the most useful localisation technique remains venous hormone assay.

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