Experienced Scintigraphers Contribute to Success of Minimally Invasive Parathyroidectomy by Skilled Endocrine Surgeons

Clark, Paige B.; Case, Doug; Watson, Nat E.; Morton, Kathryn A.; Perrier, Nancy D.
June 2003
American Surgeon;Jun2003, Vol. 69 Issue 6, p478
Academic Journal
Minimally invasive parathyroidectomy (MIP) has become the preferred surgical treatment for selected patients diagnosed with primary hyperparathyroidism (PHPT) at our tertiary-care center. Preoperative scintigraphy establishes the position of a parathyroid adenoma, dictates the incision site, and can minimize incision size and consequent tissue dissection. We reviewed our database and sought to identify factors that led to discordant preoperative imaging and operative findings and to assess the effect of experience on these findings. A retrospective review was performed on all patients with biochemically proven PHPT who underwent Tc-99m sestamibi scintigraphy and surgical intervention. Patient demographics, date of surgical intervention, scintigraphic localization, surgical findings, pre- and postoperative biochemical markers, histopathology, coexisting thyroid pathology, and 6-month follow up were recorded. Preoperative images that were discordant with operative findings were independently reviewed. Parathyroid scintigraphy was performed on 125 consecutive patients for PHPT between November 1999 and January 2002. Seventy-six patients had MIPs, 35 had standard cervical explorations, 11 had MIPs that were converted to standard cervical explorations, and three had surgery directed to an ectopic location. At 6-month follow-up 98.4 per cent were cured. Preoperative imaging and surgical findings were ipsilateral and concordant in 105 of 118 (89%) patients with parathyroid adenoma. The anatomic origin of an adenoma was predicted in only 83 of 118 (68%) patients. Most of the inaccurate scintigraphy readings occurred during the first 13 of the 26 months that MIPs were performed at our institution. Only two discordant cases occurred during the last 9 months of this period. Biochemical markers, prior neck operation, and concomitant thyroid pathology had no correlation with imaging sensitivity. Scintigraphic interpretation of smaller adenomas was less reliable;...


Related Articles

  • Imaging for primary hyperparathyroidism—an evidence-based analysis. Mihai, Radu; Simon, Dietmar; Hellman, Per // Langenbeck's Archives of Surgery;Oct2009, Vol. 394 Issue 5, p765 

    Imaging in patients with primary hyperparathyroidism has been proven difficult. During the last decade, sestamibi scintigraphy and ultrasound (US) have been used with various success. The importance of these procedures has risen since minimal invasive parathyroid (MIP) surgery also has...

  • QuiCk-IntraOperative Bio-Intact PTH Assay at Parathyroidectomy for Secondary Hyperparathyroidism. Matsuoka, Susumu; Tominaga, Yoshihiro; Sato, Tetsuhiko; Uno, Nobuaki; Goto, Norihiko; Katayama, Akio; Uchida, Kazuharu; Takami, Hiroshi // World Journal of Surgery;Apr2007, Vol. 31 Issue 4, p824 

    In uremic patients, metabolism of 1-84 parathyroid hormone (PTH) and fragments are delayed, and in these patients, the usefulness of intraoperative PTH assay may be problematic. We evaluated the usefulness of the QuiCk-IntraOperative Bio-Intact PTH (QPTH) assay for uremic patients with secondary...

  • Primary Hyperparathyroidism: An Analysis of Failure of Parathyroidectomy. Bagul, A.; Patel, H.; Chadwick, D.; Harrison, B.; Balasubramanian, S. // World Journal of Surgery;Mar2014, Vol. 38 Issue 3, p534 

    Background: Preoperative imaging in patients undergoing surgery for primary hyperparathyroidism (PHPT) is used primarily to facilitate targeted parathyroidectomy. Failure of preoperative localisation mandates a bilateral exploration. It is thought that the results of imaging may also predict the...

  • Outpatient video-assisted thoracoscopic surgery (VATS) for ectopic mediastinal parathyroid adenoma: a case report and review of the literature. Chae, Andrew W.; Perricone, Anthony; Brumund, Kevin T.; Bouvet, Michael // Journal of Laparoendoscopic & Advanced Surgical Techniques;Jun2008, Vol. 18 Issue 3, p383 

    Up to 20% of abnormal parathyroid glands causing primary or secondary hyperparathyroidism are located ectopically. Of these, approximately 1%-2% reside in the mediastinum and may not always be resectable through a traditional cervical approach. Recently, video-assisted thoracoscopic surgery...

  • Sensitivity and Utility of Parathyroid Scintigraphy in Patients with Primary Versus Secondary and Tertiary Hyperparathyroidism. Pham, Tuan H.; Sterioff, Sylvester; Mullan, Brian P.; Wiseman, Gregory A.; Sebo, Thomas J.; Grant, Clive S. // World Journal of Surgery;Mar2006, Vol. 30 Issue 3, p327 

    Introduction: Parathyroid scintigraphy (PS) may be used to localize hyperactive parathyroid glands preoperatively. Performance of PS in the setting of secondary and tertiary hyperparathyroidism (HPT) is not well quantified. The performance of PS in secondary/tertiary HPT versus primary HPT may...

  • Hyperparathyroidism in the Elderly Patient. Sims, Rebecca; Ubhi, Charanjeit; Hosking, David // Drugs & Aging;2004, Vol. 21 Issue 15, p1013 

    Primary hyperparathyroidism is a common metabolic bone disease and currently presents a significant management dilemma. Most of the patients have few relevant symptoms and surgical parathyroidectomy offers the prospect of cure with freedom from the risk of long-term complications or the need for...

  • Unexpected Results Using Rapid Intraoperative Parathyroid Hormone Monitoring during Parathyroidectomy for Primary Hyperparathyroidism. Emmolo, Ignazio; Corso, Herbert Dal; Borretta, Giorgio; Visconti, Gianluca; Piovesan, Alessatidro; Cesario, Flora; Borghi, Felice // World Journal of Surgery;Jun2005, Vol. 29 Issue 6, p785 

    Rapid intraoperative parathyroid hormone (RIOPTH) monitoring predicts complete removal of all hypersecreting tissue by means of a significant parathyroid hormone (PTH) decrease. In this study we have tried to provide an explanation for some unexpected results of RIOPTH monitoring observed during...

  • Normalization of reversed bio-intact-PTH(1-84)/intact-PTH ratio after parathyroidectomy in a patient with severe secondary hyperparathyroidism. Tanaka, M.; Itoh, K.; Matsushita, K.; Fujii, H.; Fukagawa, M. // Clinical Nephrology;2005, Vol. 64 Issue 1, p69 

    The conventional intact-PTH assay detects both (1-84)-PTH and C-terminal fragments. The newer PTH assays, bio-intact-PTH assay and whole-PTH assay, use an antibody that binds only if the first amino acid is present, making it specific for the complete molecule, (1-84)-PTH. Thus, the intact-PTH...

  • Bilateral Giant Mediastinal Parathyroid Adenomas Presented With Severe Hypercalcemia: Report of a Case. Bayraktar, Baris; Demiral, Gokhan; Ozemir, Ibrahim Ali; Bayraktar, Onur; Yilmabasar, Mehmet Gokce; Boluk, Salih // Journal of Medical Cases;2014, Vol. 5 Issue 3, p167 

    Primary hyperparathyroidism (PHPT) is a common disorder of parathyroid gland and mostly results from parathyroid adenoma with the excess production of parathyroid hormone, usually causing hypercalcemia. This is the most common reason for surgical removal of parathyroid glands. It is mostly seen...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics