scholarly journals Single Center Experience in the Surgical Management of Primary Hyperparathyroidism

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.

scholarly journals Added Value of Subtraction SPECT/CT in Dual-Isotope Parathyroid Scintigraphy

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 639 ◽  
Author(s):  
Julie Wulf Christensen ◽  
Martin Krakauer
Keyword(s):  
Computed Tomography ◽  
Primary Hyperparathyroidism ◽  
Added Value ◽  
Dual Method ◽  
Preoperative Imaging ◽  
Emission Computed Tomography ◽  
Parathyroid Scintigraphy ◽  
Dual Isotope ◽  
Single Method ◽  
Subtraction Scintigraphy

Background: Adding subtraction single-photon emission computed tomography/computed tomography (SPECT/CT) to dual isotope (I-123 and Tc-99m-sestamibi) subtraction parathyroid scintigraphy is not widely implemented. We aimed to assess the added value of dual isotope subtraction SPECT/CT over single isotope SPECT/CT as an adjunct to dual isotope planar pinhole subtraction scintigraphy. Methods: Parathyroid scintigraphies from 106 patients with an estimated total of 415 parathyroid glands who (1) were diagnosed with primary hyperparathyroidism, (2) underwent dual isotope subtraction scintigraphy in the Department of Nuclear Medicine, Gentofte Hospital, Denmark throughout 2017 and (3) underwent subsequent parathyroidectomy, were included. The original dual isotope planar pinhole subtraction plus dual isotope subtraction SPECT/CT (dual/dual method) exams were retrospectively re-evaluated using only Tc-99m-sestamibi SPECT/CT (dual/single method). Statistics were calculated per parathyroid. Surgical results confirmed by pathology served as reference standard. Results: The dual/dual method had higher sensitivity than the dual/single method (82% (95%CI 74%–88%) vs. 69% (95%CI 60%–77%)) while specificity, positive and negative predictive values (PPV and NPV) were similar (specificity 96% vs. 93%, PPV’s 87% vs. 82% and NPV’s 89% vs. 93%). Reader confidence was higher when employing the dual/dual method (p = 0.001). Conclusions: The dual/dual method can be considered superior to the dual/single method in the preoperative imaging in primary hyperparathyroidism.

Accuracy of Dual Phase Single-Photon Emission Computed Tomography/Computed Tomography in Primary Hyperparathyroidism: Correlation with Serum Parathyroid Hormone Levels

2016 ◽  
Vol 67 (2) ◽  
pp. 115-121 ◽  
Author(s):  
Wade Koberstein ◽  
Christopher Fung ◽  
Kristy Romaniuk ◽  
Jonathan T. Abele
Keyword(s):  
Computed Tomography ◽  
Primary Hyperparathyroidism ◽  
Predictive Value ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Dual Phase ◽  
Parathyroid Adenomas ◽  
Ectopic Parathyroid ◽  
Serum Pth

Purpose The objectives of this study were: 1) to determine the accuracy of dual-phase 99mTc -methoxyisobutylisonitrile (MIBI) with single-photon emission computed tomography/computed tomography (SPECT/CT) for the preoperative localization of parathyroid adenomas in the setting of primary hyperparathyroidism; 2) to determine the accuracy of localization for ectopic glands; and 3) to assess the relationship between accuracy and serum parathyroid hormone (PTH) levels. Methods Eighty-eight patients who underwent 99mTc-MIBI SPECT/CT imaging for primary hyperparathyroidism at our institution over a 27-month period were retrospectively assessed. The preoperative SPECT/CT results were compared to intraoperative findings (within 1 year of imaging). The relationship between serum PTH level (within 3 months) and SPECT/CT accuracy was then evaluated. Results Accuracy indices for the retrothyroid subgroup were sensitivity 86.7%, specificity 96.4%, positive predictive value 98.1%, negative predictive value 77.1%, and accuracy 89.8%. Accuracy indices for ectopic parathyroid adenomas were sensitivity 81.5%, specificity 100%, positive predictive value 100%, negative predictive value 92.4%, and accuracy 94.3%. For the overall group, SPECT/CT demonstrated a sensitivity of 85.1% and a PPV of 98.7%. SPECT/CT correctly identified the abnormal parathyroid gland in 60% of patients with a normal serum PTH (<6.9 pmol/L), 73% between 6.9-9.9 pmol/L, 86% between 10.0-14.9 pmol/L, 100% between 15.0-19.9 pmol/L, 88% between 20.0-24.5 pmol/L, and 100% of patients with a PTH greater than 25.0 pmol/L. Conclusions Dual-phase 99mTc- MIBI with SPECT/CT is an accurate and reliable means to correctly localize both retrothyroid and ectopic parathyroid adenomas for the purpose of surgical planning. The accuracy of SPECT/CT increases with increasing serum PTH levels.

scholarly journals Ectopic Parathyroid Adenoma in Piriform Sinus: Case Report and Review of the Literature

2019 ◽  
Vol 98 (1) ◽  
pp. 14-17
Author(s):  
Michael J. Connolly ◽  
Dorothy Lazinski ◽  
Katherine A. Aoki ◽  
Laurie McLean ◽  
Carlos Torres ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Parathyroid Adenoma ◽  
Emission Computed Tomography ◽  
Piriform Sinus ◽  
Ectopic Parathyroid Adenoma ◽  
Sestamibi Scintigraphy ◽  
Parathyroid Adenomas ◽  
Ectopic Parathyroid ◽  
The Right ◽  
Increased Activity

During routine blood work, a 53-year-old female patient was noted to have asymptomatic hypercalcemia and subsequently found to have hyperparathyroidism. Localization studies for a suspected parathyroid adenoma included 99mTc Sestamibi scintigraphy, Single Photon Emission Computed Tomography (SPECT)/computed tomography (CT) study, and ultrasound of the neck, which were initially read as negative for parathyroid adenoma. A contrast-enhanced CT scan of the neck was performed to locate the suspected parathyroid adenoma and demonstrated a soft tissue lesion within the right piriform sinus. Flexible fiber optic nasolaryngoscopy revealed a submucosal lesion in the right piriform sinus. Following these findings, the initial 99mTc Sestamibi scintigraphy and SPECT/CT were reviewed with confirmation of a focal area of increased activity superior to the right thyroid lobe, corresponding to a nodule in the right piriform sinus that demonstrated increased activity on SPECT/CT. The patient was brought to the operating room for surgical management where a laryngoscope and operating microscope were utilized. The encapsulated lesion was dissected and excised in total. The parathyroid hormone and ionized calcium levels normalized postoperatively. Pathology confirmed a parathyroid adenoma. Parathyroid adenomas are the most common cause of primary hyperparathyroidism. Sixteen percent of parathyroid adenomas can be situated in an ectopic location. Ectopic parathyroid adenomas in the piriform sinus are rare with only a few previously documented cases. We document a rare case of ectopic parathyroid adenoma in the piriform sinus overlooked on initial imaging studies. These lesions can be challenging to localize, however, an understanding of embryology, close scrutiny of possible ectopic locations, and the application of complementary imaging techniques may prove useful for surgeons and clinicians.

scholarly journals Factors That Affect the Sensitivity of Imaging Modalities in Primary Hyperparathyroidism

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Minting Zhu ◽  
Yang He ◽  
Tingting Liu ◽  
Bei Tao ◽  
Weiwei Zhan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Primary Hyperparathyroidism ◽  
Preoperative Localization ◽  
Imaging Modalities ◽  
Emission Computed Tomography ◽  
Imaging Results ◽  
Parathyroid Lesions ◽  
99Mtc Mibi ◽  
Serum Pth ◽  
Mibi Spect

Background. Cervical ultrasound, 99mTc-sestamibi single-photon emission computed tomography/computed tomography (99mTc-MIBI SPECT/CT), and cervical CT are routinely used in preoperative localization of primary hyperparathyroidism (PHPT). However, false-negative imaging results are also frequently encountered in clinical practice. Exploring the factors that affect the sensitivity of these imaging modalities is important for the surgical management of PHPT patients. Methods. Clinical data of 352 PHPT patients hospitalized in our center from January 2011 to December 2015 were retrospectively collected to evaluate the sensitivity of 3 imaging modalities in the preoperative localization of parathyroid lesions. The ROC curve analysis was used to explore the clinical factors affecting the sensitivity of localization, and the cut-point(s) of related factors were determined. Results. 99mTc-MIBI SPECT/CT has the highest sensitivity among the localization modalities commonly used, reaching 91.1% (86.0%–94.8%). When the lengths of parathyroid lesions were ≤1.3 cm, the sensitivity of neck ultrasonography significantly decreased, while the sensitivity of 99mTc-MIBI SPECT/CT decreased with parathyroid lesions ≤1.3 cm or serum PTH≤252 pg/ml. 99mTc-MIBI SPECT/CT was less effective in localizing the hyperplasia lesions. Neck ultrasonography combined with 99mTc-MIBI SPECT/CT can effectively improve the accuracy of preoperative localization of parathyroid lesions to 96.2% (92.7%–98.1%). Conclusions. Small parathyroid lesion and mild elevation of serum PTH would reduce the accuracy of parathyroid localization in PHPT patients.

scholarly journals An Unusual Case of Primary Hyperparathyroidism: Case Report of a Bifocal Intrathyroidal Parathyroid Carcinoma

2020 ◽  
pp. 014556132097746
Author(s):  
Maxime Damien ◽  
Alexandra Rodriguez ◽  
Pierre Kleynen ◽  
Didier Dequanter ◽  
Cyril Bouland
Keyword(s):  
Computed Tomography ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Carcinoma ◽  
Photon Emission ◽  
Parathyroid Tissue ◽  
Emission Computed Tomography ◽  
Thyroid Lobe ◽  
Imaging Results ◽  
Pet Ct ◽  
Left Thyroid Lobe

Intrathyroidal parathyroid carcinoma is an extremely rare cause of primary hyperparathyroidism. We reported a 51-year old woman who presented symptoms of hypercalcemia. 99mTc sestamibi single-photon emission computed tomography/computed tomography (CT) revealed a large hypermetabolic nodule in the left thyroid lobe suggestive of hyperfunctioning parathyroid tissue. 11C-methionine positron emission tomography/computed tomography (PET/CT) and 18F-fluorocholine PET/CT confirmed the nodule in the left thyroid lobe and also revealed a hypermetabolic activity on the posterior surface of the lower left pole. The patient underwent a total thyroidectomy and parathyroidectomy, and a diagnosis of bifocal intrathyroidal parathyroid carcinoma was confirmed. We present the first reported case of bifocal intrathyroidal carcinoma and discuss the discordant imaging results.

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