scholarly journals Usefulness of the Wisconsin and CaPTHUS indices for predicting multiglandular disease in patients with primary hyperparathyroidism in a southern European population

Gland Surgery ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 861-869
Author(s):  
Mario Serradilla-Martín ◽  
Ana Palomares-Cano ◽  
Miguel Cantalejo-Díaz ◽  
Mónica Mogollón-González ◽  
Esther Brea-Gómez ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
European Population ◽  
Multiglandular Disease

Surgeon-Performed Ultrasound Improves Localization of Abnormal Parathyroid Glands

2005 ◽  
Vol 71 (7) ◽  
pp. 557-563 ◽  
Author(s):  
Carmen C. Solorzano ◽  
Theresa M. Lee ◽  
Marcela C. Ramirez ◽  
Denise M. Carneiro ◽  
George L. Irvin
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Thyroid Tissue ◽  
Parathyroid Tissue ◽  
Initial Step ◽  
Multiglandular Disease ◽  
Venous Sampling ◽  
Sporadic Primary Hyperparathyroidism ◽  
Operative Findings ◽  
Abnormal Tissue

With a secure diagnosis of hyperparathyroidism, preoperative localization of abnormal glands is the initial step toward limited parathyroidectomy (LPX). We investigated whether ultrasonography in the hands of the surgeon (SUS) could improve the localization of abnormal parathyroids when sestamibi scans (MIBI) were negative or equivocal. One hundred eighty patients with sporadic primary hyperparathyroidism (SPHPT) underwent preoperative SUS and MIBI scans before LPX guided by intraoperative parathormone assay. When the sestamibi scans were negative, SUS was used to localize the parathyroid, distinguish parathyroid from thyroid tissue, and to guide the intraoperative jugular venous sampling for differential elevation of parathyroid hormone (PTH). Operative findings, intraoperative hormone dynamics, and postoperative calcium levels determined successful localization. MIBI was negative or equivocal in 36/180 (20%) patients: 1) showed no parathyroid gland in 22 patients, 2) suggested an incorrect location for the abnormal gland in 9, and 3) was insufficient in recognizing multiglandular disease in 5. In these 36 patients, the addition of SUS led to the successful identification of the abnormal tissue in 19/36 (53%). In the remaining 17 patients with negative/equivocal scans, the parathyroid could not be clearly visualized by SUS. In these patients, SUS facilitated LPX by aiding preoperative transcutaneous jugular venous sampling for differentially elevated PTH (n = 3) and identifying questionable thyroid nodule versus parathyroid tissue (n = 1). Overall, SUS was useful in 23/36 (67%) patients with nonlocalizing MIBI scans, thus improving the rate of localization from 80 per cent to 93 per cent ( P < 0.01). Surgeon-performed cervical ultrasonography improved the localization of abnormal parathyroids by MIBI scan, adding to the success of limited parathyroidectomy.

Role of preoperative intact parathyroid hormone levels in predicting the likelihood of multiglandular disease in primary hyperparathyroidism

Head & Neck ◽  
2010 ◽  
Vol 33 (4) ◽  
pp. 543-546
Author(s):  
Emad Kandil ◽  
Kathryn A. Carson ◽  
Anthony P. Tufaro ◽  
Obai Abdullah ◽  
Haytham Alabbas ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Intact Parathyroid Hormone ◽  
Multiglandular Disease ◽  
Hormone Levels

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.

Mild sporadic primary hyperparathyroidism: high rate of multiglandular disease is associated with lower surgical cure rate

2019 ◽  
Vol 404 (4) ◽  
pp. 431-438 ◽  
Author(s):  
Emmanuelle Trébouet ◽  
Sahar Bannani ◽  
Matthieu Wargny ◽  
Christophe Leux ◽  
Cécile Caillard ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
High Rate ◽  
Multiglandular Disease ◽  
Cure Rate ◽  
Surgical Cure ◽  
Sporadic Primary Hyperparathyroidism

Negative preoperative localization studies are highly predictive of multiglandular disease in sporadic primary hyperparathyroidism

Surgery ◽  
2003 ◽  
Vol 134 (6) ◽  
pp. 1038-1041 ◽  
Author(s):  
Frederic Sebag ◽  
Johnathan G.H Hubbard ◽  
Sylvie Maweja ◽  
Claudia Misso ◽  
Laurent Tardivet ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Preoperative Localization ◽  
Multiglandular Disease ◽  
Sporadic Primary Hyperparathyroidism

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.

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