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Parathyroid Adenoma (parathyroid + adenoma)
Kinds of Parathyroid Adenoma Selected AbstractsUltrasonography: Highly Accuracy Technique for Preoperative Localization of Parathyroid Adenoma,THE LARYNGOSCOPE, Issue 9 2008Bassam Abboud MD Abstract Objectives/Hypothesis: This study evaluates the accuracy of ultrasonography in guided unilateral parathyroidectomy to treat primary hyperparathyroidism. Study Design: Retrospective study. Methods: Two hundred fifty-three patients with primary hyperparathyroidism underwent preoperative ultrasonography. Two groups were defined. Group 1 included the patients in whom the preoperative cervical ultrasound localized one abnormal parathyroid gland; these patients underwent unilateral surgical exploration of the neck under local anesthesia. Group 2 included the patients who had a bilateral neck exploration under general anesthesia when the preoperative examination was equivocal or failed to localize the lesion, when concomitant thyroid pathology indicated thyroidectomy, and when justified by the surgical findings. Results: Sensitivity and positive predictive value of ultrasonography in detecting abnormal parathyroid gland were 96% and 98%, respectively. Cervical ultrasound correctly identified, 96% and 85% of abnormal glands in groups 1 and 2, respectively. The presence of thyroid nodular disease did not affect ultrasonographic accuracy. Sonographic examination decreased the operative time of parathyroidectomy to an average of 15 minutes. Mediastinal and retroesophageal localizations of abnormal parathyroid gland adversely affected the accuracy of the ultrasound. No cervical hematoma was noted. Transient recurrent laryngeal nerve palsy occurred in four patients. Twenty-three patients required postoperative calcium supplementation for 2 to 4 months, and all were normocalcemic at follow-up. Conclusions: Cervical ultrasound is a reliable preoperative exploration allowing parathyroidectomy via unilateral approach under local anesthesia. [source] Cytopathologist-performed ultrasound-guided fine-needle aspiration of parathyroid lesions,DIAGNOSTIC CYTOPATHOLOGY, Issue 5 2010David Lieu M.D., M.B.A. Abstract The gold standard to determine the cause of primary hyperparathyroidism (PHPT) is bilateral neck exploration. As most cases are caused by parathyroid adenoma, there is a movement toward preoperative localization of the abnormal gland by ultrasound and/or Tc99 -sestamibi scan and minimally invasive parathyroidectomy. Nonpalpable thyroid nodules are common and cannot be differentiated from parathyroid lesions by imaging alone. This study examines cytopathologist-performed ultrasound-guided fine-needle aspiration (UG-FNA) in diagnosis of parathyroid lesions. Between January 1, 2007 and December 31, 2008, seven patients with PHPT or other parathyroid lesions with one or more sonographically-visible thyroid masses underwent cytopathologist-performed UG-FNA with immediate cytological evaluation (ICE). One mass was palpable and nine were nonpalpable. Three parathyroid adenomas, two benign colloid nodules, one papillary carcinoma, three parathyroid cysts, and one thyroid cyst were diagnosed. The nodules in three patients with parathyroid adenomas were identified as follicular lesion/neoplasm on ICE. Additional UG-FNA passes were made to obtain tissue for immunohistochemistry stains, which confirmed parathyroid origin. Two of these patients had a separate benign colloid nodule and one had a thyroid cyst diagnosed by UG-FNA. The PHPT patient with papillary carcinoma on UG-FNA had the malignancy confirmed at surgery and a sonographically occult parathyroid adenoma. The three patients with thyroid cysts identified by radiology were suspected of being parathyroid cysts on the basis of real-time sonographic features at the biopsy table. The clear cyst fluid obtained by UG-FNA had markedly elevated PTH. Cytopathologist-performed UG-FNA can distinguish between parathyroid and thyroid nodules in patients with suspected parathyroid lesions. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source] Accuracy and definitive interpretation of preoperative technetium 99m sestamibi imaging based on the discipline of the reader,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2009Ayesha N. Khalid MD Abstract Background. Technetium 99m sestamibi scans have become a principal means of localizing parathyroid adenomas. Its accuracy and reliability has allowed for the proliferation of minimal access parathyroidectomy. Localizing interpretation of these scans often drives referral of hyperparathyroid patients for surgery. Interpretation of these scans may differ between nuclear medicine physicians and surgeons. Methods. We reviewed patients (N = 65) with digital images from an academic medical center with the diagnosis of primary hyperparathyroidism. We assessed the willingness to define an adenoma's location, the interrater reliability, and the accuracy of technetium (Tc-99m) sestamibi read by a surgeon and a nuclear medicine physician. Results. There was poor correlation between both readers for assessment of quality of images (k = 0.54, 0.07) but very good correlation for adenoma location (k = 0.81). Conclusion. Both readers had good accuracy in predicting the location of the parathyroid adenoma. The surgeon was more likely to call a scan positive. © 2008 Wiley Periodicals, Inc. Head Neck, 2009 [source] Accuracy of technetium-99m SPECT-CT hybrid images in predicting the precise intraoperative anatomical location of parathyroid adenomasHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2008Luke Harris MD Abstract Background. This study evaluated the accuracy of single photon emission computed tomography (SPECT)-CT imaging for the preoperative localization of parathyroid adenomas. Methods. This study included both a quantitative and qualitative accuracy measure. The quantitative measure was the distance between the location of the adenoma on the SPECT-CT scan and the location of the adenoma intraoperatively. Qualitatively, surgeons were asked whether or not the adenoma was in the exact location predicted by the SPECT-CT scan. The time from initial incision to identification of the parathyroid was recorded. Patients referred to London Health Sciences Centre for a suspected parathyroid adenoma were eligible for this study. Results. Twenty-three patients participated in this study. Eighteen (78.3%) had a single adenoma, 2 (8.7%) had double adenomas, and 3 (13.0%) had multiglandular hyperplasia. SPECT-CT correctly detected and localized 16 of 18 (88.9%) cases of single parathyroid adenomas. The mean distance between the location of the adenoma on the SPECT-CT scan and the location of the adenoma intraoperatively was 16.3 mm (95% , 19.0 mm). For single adenomas, the median time from skin incision to identification was 14 minutes (range, 8,40 minutes). The preoperative detection and localization of a single focus of sestamibi uptake yielded a parathyroid adenoma in the specified location in 80.0% of cases (95% CI, 97.4,66.5%). Conclusions. SPECT-CT predicted the intraoperative location of a single parathyroid adenoma within 19.0 mm with 95% confidence. The correct detection and localization of multiglandular disease remains difficult. © 2007 Wiley Periodicals, Inc. Head Neck, 2008 [source] Preoperative evaluation of patients with parathyroid adenoma: Role of high-resolution ultrasonography,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2002David Ulanovski MD Abstract Background Unilateral parathyroid exploration with adenoma removal and identification of a normal parathyroid gland is a controversial surgical approach to the treatment of primary hyperparathyroidism. The aim of this study was to evaluate the ability of high-resolution ultrasonography to localize adenomas preoperatively and to assess the effect of such localization on operative time. Methods One hundred twenty consecutive previously non-operated patients with primary hyperparathyroidism underwent ultrasonography before surgery, which consisted of unilateral neck exploration. The procedure was changed to bilateral exploration when justified by the surgical findings. Results The sensitivity and positive predictive value of the ultrasonographic examinations were 89% and 98%, respectively. These results were obtained regardless of the size of the adenoma. No significant difference was found in the presence of thyroid multinodular disease (p = .2). A positive sonographic examination decreased the operative time to an average of 59 minutes. The average size of the adenomas was 19 mm (range, 4,55 mm). A positive and highly statistically significant correlation was found between adenoma size and both preoperative calcium level (p = .01) and parathyroid hormone level (p = .0001). Conclusions In experienced hands, high-resolution ultrasonography can be a cost-effective means of localizing parathyroid adenomas when unilateral neck exploration is considered the acceptable surgical approach. © 2002 John Wiley & Sons, Inc. Head Neck 24: 1,5, 2002. [source] Immunohistochemical assessment of parafibromin in mouse and human tissuesJOURNAL OF ANATOMY, Issue 6 2006Andrea Porzionato Abstract Parafibromin is a protein encoded by the HRPT2 oncosuppressor gene, whose mutation causes the hyperparathyroidism,jaw tumour syndrome, characterized by the occurrence of parathyroid adenoma or carcinoma, fibro-osseous jaw tumours, and renal neoplastic and non-neoplastic abnormalities. Non-morphological techniques, such as Northern and Western blotting and reverse transcriptase-PCR, indicate that parafibromin is ubiquitously expressed, but extensive immunohistochemical studies have not been performed. To increase our knowledge of the distribution and patterns of expression of parafibromin, we examined its expression and location in many different mouse and human organs by immunohistochemistry. There were no substantial differences in parafibromin expression between mouse and human. We found widespread expression of parafibromin, except in connective tissue, smooth muscle, endothelium and some other types of epithelia (colonic, urinary, tubaric, uterine, thyroid). Heterogeneity of positivity intensity and subcellular location (nuclear, nucleocytoplasmic, cytoplasmic) was found between tissues and cell types, suggesting differential functional involvement of parafibromin. Moreover, higher parafibromin expression was found in cell types, such as hepatocytes, cells of the base of gastric glands, renal cortex tubules and the pars intermedia of the hypophysis, which are characterized by different proliferative capacity, thus indicating that the cellular function of parafibromin may not be reduced only to its anti-proliferative effect. [source] Chondrosarcoma in Association With Primary Hyperparathyroidism,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 7 2004Ajay Bhatia Abstract We describe two female patients, 66 and 36 years of age, with both primary hyperparathyroidism and chondrosarcoma. Case 1 had a chondrosarcoma of the right scapula, and case 2 had chondrosarcoma of the left proximal tibia. Both patients underwent surgical resection of their chondrosarcoma and subsequent parathyroid surgery. Histological analysis of the excised parathyroid in case 1 showed a parathyroid carcinoma and in case 2 showed a parathyroid adenoma. Including these two patients, there is now a total of six cases that have been reported in the literature describing the association between hyperparathyroidism and bone malignancy. We believe that this small number makes it unlikely that there is an association between these two conditions, although we speculate that there may be an underlying genetic basis. [source] Preoperative localization of parathyroid adenoma with sonography and 99mTc-sestamibi scintigraphy in primary hyperparathyroidismJOURNAL OF CLINICAL ULTRASOUND, Issue 4 2007Ilaria Grosso MD Abstract Purpose. To evaluate the sensitivity, specificity, and usefulness of dual-phase 99mTc-Sestamibi scintigraphy (SS) and sonography (US) of the neck, alone and in combination, as noninvasive adenoma localizing procedures in patients with primary hyperparathyroidism prior to parathyroidectomy. Methods. We retrospectively analyzed the charts of 79 patients with parathyroid (PT) adenomas and confirmed diagnosis of hyperparathyroidism who were evaluated with SS and US prior to successful parathyroidectomy. Results. Ninety-three adenomas were removed during bilateral neck exploration. SS alone showed a sensitivity of 76% and a specificity of 79% compared with 89% and 75%, respectively, for US performed after SS on the same day. Combination of the 2 procedures yielded a sensitivity of 89% and a specificity of 90%, with 22% discordant results. The differences in sensitivity and specificity between the 2 techniques alone or in combination were not statistically significant. Conclusions. No benefit was gained from using both SS and US for the preoperative localization of PT adenomas in patients with primary hyperparathyroidism. Each technique can be negatively affected by thyroid enlargment and nodularity. US, when performed by a skilled operator, is a reliable tool for PT adenoma localization. If the US findings are inconclusive, SS should be used. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2007 [source] Surviving extreme hypercalcaemia , a case report and review of the literatureJOURNAL OF INTERNAL MEDICINE, Issue 1 2005K. MARIENHAGEN Abstract. We report a case of extreme hypercalcaemia associated with a parathyroid adenoma in a young man. The patient presented with classical symptoms of a hypercalcaemic syndrome, and serum calcium and parathyroid hormone levels were 6.92 mmol L,1 and 70.2 pmol L,1 respectively. After stabilizing the patient and reducing the calcium level, a parathyroidectomy was performed. The postoperative course was uneventful with rapidly resolving clinical symptoms. Hypercalcaemic crisis is a rare but life-threatening complication of primary hyperparathyroidism. It should be suspected in acutely ill patients complaining of muscular weakness, gastrointestinal and cerebral symptoms. To reduce mortality, it is essential to correctly diagnose the condition without delay and provide appropriate emergency management correcting hypercalcaemia and dehydration. Successful parathyroidectomy quickly relieves symptoms and prevents recurrence. [source] Correlation of Intraoperative Parathyroid Hormone Levels With Parathyroid Gland Size,THE LARYNGOSCOPE, Issue 11 2007William H. Moretz III MD Abstract Objectives: To study the relationship of intraoperative intact parathyroid hormone levels (iPTH) with parathyroid adenoma weight and volume in patients with primary hyperparathyroidism. Methods: Retrospective evaluation of consecutive patients undergoing minimally invasive parathyroidectomy with iPTH measurement. Data collected include preoperative serum calcium, ionized calcium, and serum parathyroid hormone (PTH) levels, iPTH levels at baseline, 5 minutes, and 10 minutes, and parathyroid adenoma weight. Adenoma volume was calculated using an equation for the volume of a spheroid object. Results: Thirty patients underwent minimally invasive parathyroidectomy with iPTH measurement for a single parathyroid adenoma between March 2004 and January 2006. There were 8 men and 22 women, with a mean age of 59.3 (range 26,92) years. A significant correlation between preoperative serum calcium and ionized calcium levels and parathyroid adenoma weight was identified (P = .0008 and P = .03, respectively). A significant correlation was also shown between baseline iPTH measurements and parathyroid adenoma volume (P = .03). There was no correlation between baseline iPTH levels and parathyroid adenoma weight. There was a significant correlation between parathyroid adenoma weight and percentage decrease of iPTH levels at 10 minutes compared to baseline (P = .04). Conclusion: Preoperative serum calcium and baseline iPTH levels may be useful in predicting parathyroid adenoma weight and volume, respectively. Adenoma weight may relate to the percentage decrease of iPTH levels at the 10-minute postparathyroidectomy interval. [source] Revival of parathyroid adenoma: a rare cause of recurrent hyperparathyroidismANZ JOURNAL OF SURGERY, Issue 6 2008Abhijit Thakur MS No abstract is available for this article. [source] Minimally invasive parathyroidectomy for recurrent or persistent hyperparathyroidism using carbon track localizationANZ JOURNAL OF SURGERY, Issue 10 2003Robert J. Kennedy Background: The present study documents the use of carbon tracking to localize parathyroid adenomas in three patients with persistent or recurrent parathyroid disease. Methods: Three patients requiring second or third operations for hyperparathyroidism were operated upon after the parathyroid lesion had been localized preoperatively using a suspension of carbon particles in water. The enlarged parathyroid glands were identified by using one or more of the following: computed axial tomography, magnetic resonance imaging, ultrasound or Sestamibi nuclear scan. The lesion was then localized with ultrasound or computed axial tomography and a carbon track was inserted from the lesion to the skin, leaving a small skin tattoo as a marker for the surgeon. Each patient underwent a minimally invasive parathyroid operation. Results: For each of the three patients the recurrent or persistent parathyroid adenoma was successfully identified and removed via a small incision. Conclusion: Minimally invasive techniques for primary hyperparathyroidism are changing our approach to parathyroid surgery. However, a minimally invasive technique is less applicable when the disease is persistent or recurrent. Although, when the recurrent or persistent parathyroid adenoma can be identified, localization and carbon tracking have proved useful in allowing the surgeon to remove the lesion via a minimally invasive technique. [source] Resection of ectopic mediastinal parathyroid glands with the da Vinci® robotic systemBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2010M. Ismail Background: Mediastinal ectopic parathyroid adenoma is a frequent cause of persistent or recurrent hyperparathyroidism, traditionally treated by open surgery. Thoracoscopic access is associated with reduced morbidity in mediastinal surgery. The aim of this study was to evaluate the feasibility and effectiveness of robot-assisted dissection for mediastinal ectopic parathyroid glands. Methods: Two patients with recurrent secondary hyperparathyroidism and three with complicated primary hyperparathyroidism were operated on between July 2004 and August 2008 for ectopic mediastinal parathyroid glands. Fusion of single-photon emission computed tomography and computed tomography led to an exact identification of the culprit glands. Surgery was performed thoracoscopically with the da Vinci® robotic system using a three-trocar approach. Results: All procedures were completed successfully with the robotic system. No perioperative morbidity or mortality was noted. Median operating time was 58 (range 42,125) min. Intraoperative parathyroid hormone reduction indicated complete resection. Median hospital stay was 3 (range 2,4) days. Conclusion: Robot-assisted dissection is a promising approach for resection of ectopic parathyroid glands in remote narrow anatomical locations such as the mediastinum. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Intraoperative diagnosis and treatment of parathyroid cancer and atypical parathyroid adenomaBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 5 2007G. Ippolito Background: Distinction of parathyroid cancer from atypical parathyroid adenoma (APA) at operation is difficult. The aim of this study was to determine whether parathyroid cancer and APA have different operative findings and long-term outcomes. Methods: A retrospective review was undertaken of patients with suspicious or malignant parathyroid tumours treated between 1974 and 2005. Parathyroid cancer was defined as a lesion with vascular or tissue invasion, and APA as a neoplasm with broad fibrous bands, trabecular growth, mitosis and nuclear atypia. Results: Twenty-seven patients with suspicious or malignant parathyroid tumours were identified. After histological review, parathyroid cancer was confirmed in 11 patients (group 1) and 16 tumours were classified as APA (group 2). The clinical presentation and operative findings of the two types of tumour were indistinguishable. At initial surgery, seven patients in group 1 underwent en bloc resection, and four had parathyroidectomy. Four of the seven patients who had en bloc resection had recurrences. No recurrences were observed in the other seven patients in group 1 at a median follow-up of 65 months. In group 2, eight patients had en bloc resection and eight had parathyroidectomy; no patient had recurrence at a median follow-up of 91 months. Conclusion: Operative findings cannot distinguish APA from parathyroid cancer reliably. Without evidence of macroscopic local invasion, the value of en bloc resection at initial surgery remains debatable. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Minimally invasive parathyroidectomy without intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidismBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2007R. Mihai Background: Minimally invasive parathyroidectomy (MIP) is the preferred operation for patients with primary hyperparathyroidism (HPT) and positive preoperative imaging. This non-randomized case series assessed the long-term results of MIP performed without the use of intraoperative parathyroid hormone (ioPTH) monitoring. Methods: The study involved prospective collection of demographic, biochemical and operative details on a consecutive, unselected cohort of 298 patients who underwent surgery for non-familial primary HPT during a 5-year interval. The mean preoperative serum calcium level was 3·00 mmol/l with a mean parathyroid hormone concentration of 25·8 pmol/l. 99mTc-labelled sestamibi scanning and neck ultrasonography were performed in 262 patients. Results: Sestamibi scan showed unilateral uptake in 182 patients and a single parathyroid adenoma was confirmed on ultrasonography in 161 patients. MIP was performed in 150 patients. The mean duration of operation was 25 (range 8,65) min. Four patients needed conversion to conventional neck exploration. There was one postoperative haematoma and three cases of temporary recurrent laryngeal nerve neuropraxia. All but four patients were normocalcaemic after MIP. All the parathyroid tumours removed were adenomas, with a mean weight of 1·3 (range 0·1,17·4) g. No patient developed recurrent HPT after a median follow-up of 16 (range 3,48) months. Conclusion: The outcome of MIP without ioPTH monitoring was comparable to that reported in series that used ioPTH monitoring. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Image-directed parathyroidectomy under local anaesthesia in the elderly,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 6 2003L. Biertho Background: Surgical morbidity and mortality rates are increased in elderly patients. The aim of this study was to evaluate the outcome of targeted parathyroid operations in patients over the age of 70 years. Methods: Forty patients aged over 70 years underwent targeted parathyroidectomy for primary hyperparathyroidism (HPT). Data were collected prospectively and reviewed retrospectively. Results: There were 33 women and seven men with a mean age of 78 (range 70,92) years, all of whom had symptoms attributable to HPT. A solitary parathyroid adenoma was detected by ultrasonography and/or sestamibi scintigraphy before operation in all patients. Six patients had a history of neck surgery, including two with persistent or recurrent HPT. Thirty-three patients underwent neck exploration under local anaesthesia with intravenous sedation. Following parathyroidectomy, intraoperative parathyroid hormone levels normalized in 39 of 40 patients and accurately predicted postoperative eucalcaemia. Intraoperative findings included 37 solitary adenomas, one double adenoma and two carcinomas. One patient with persistent HPT developed severe hypoparathyroidism following targeted parathyroid exploration with autotransplantation. Twenty-nine patients were discharged from hospital on the day of surgery. Nineteen of 21 patients for whom data were available reported an improvement in symptoms. Conclusion: A focused neck exploration provides a safe and effective alternative to bilateral neck exploration in elderly patients in whom a solitary parathyroid adenoma has been localized before operation. Targeted parathyroidectomy under local anaesthesia is recommended in most elderly patients with HPT. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Genetic analyses in patients with familial isolated hyperparathyroidism and hyperparathyroidism,jaw tumour syndromeCLINICAL ENDOCRINOLOGY, Issue 1 2006Noriko Mizusawa Summary Background, A subset of familial isolated primary hyperparathyroidism (FIHP) is a variant of hyperparathyroidism,jaw tumour syndrome (HPT-JT). Aim/patients and methods, We investigated the involvement of the HRPT2, MEN1 and CASR genes in 11 provisional FIHP families and two HPT-JT families. Results, Germline mutations of HRPT2 were found in two of the 11 FIHP families and one of the two HPT-JT families. One FIHP family with parathyroid carcinoma and atypical adenomas and another FIHP family with cystic parathyroid adenoma had novel frameshift mutations of 518,521del and 62,66del, respectively. In a patient with HPT-JT, a de novo germline mutation of 39delC was detected. Novel somatic HRPT2 mutations of 70,73del and 95,102del were found in two of five parathyroid tumours in a family with a 518,521del mutation. Biallelic inactivation of HRPT2 by a combination of germline and somatic mutation was confirmed in the parathyroid tumours. The finding that two families diagnosed with FIHP carried HRPT2 mutations suggests that they have occult HPT-JT. In the remaining 10 families, one family had a missense MEN1 mutation. No mutations of CASR were detected. Conclusion, Our results confirm the need to test for HRPT2 in FIHP families, especially those with parathyroid carcinomas, atypical adenomas or adenomas with cystic change. [source] Cytopathologist-performed ultrasound-guided fine-needle aspiration of parathyroid lesions,DIAGNOSTIC CYTOPATHOLOGY, Issue 5 2010David Lieu M.D., M.B.A. Abstract The gold standard to determine the cause of primary hyperparathyroidism (PHPT) is bilateral neck exploration. As most cases are caused by parathyroid adenoma, there is a movement toward preoperative localization of the abnormal gland by ultrasound and/or Tc99 -sestamibi scan and minimally invasive parathyroidectomy. Nonpalpable thyroid nodules are common and cannot be differentiated from parathyroid lesions by imaging alone. This study examines cytopathologist-performed ultrasound-guided fine-needle aspiration (UG-FNA) in diagnosis of parathyroid lesions. Between January 1, 2007 and December 31, 2008, seven patients with PHPT or other parathyroid lesions with one or more sonographically-visible thyroid masses underwent cytopathologist-performed UG-FNA with immediate cytological evaluation (ICE). One mass was palpable and nine were nonpalpable. Three parathyroid adenomas, two benign colloid nodules, one papillary carcinoma, three parathyroid cysts, and one thyroid cyst were diagnosed. The nodules in three patients with parathyroid adenomas were identified as follicular lesion/neoplasm on ICE. Additional UG-FNA passes were made to obtain tissue for immunohistochemistry stains, which confirmed parathyroid origin. Two of these patients had a separate benign colloid nodule and one had a thyroid cyst diagnosed by UG-FNA. The PHPT patient with papillary carcinoma on UG-FNA had the malignancy confirmed at surgery and a sonographically occult parathyroid adenoma. The three patients with thyroid cysts identified by radiology were suspected of being parathyroid cysts on the basis of real-time sonographic features at the biopsy table. The clear cyst fluid obtained by UG-FNA had markedly elevated PTH. Cytopathologist-performed UG-FNA can distinguish between parathyroid and thyroid nodules in patients with suspected parathyroid lesions. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source] Accuracy and definitive interpretation of preoperative technetium 99m sestamibi imaging based on the discipline of the reader,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2009Ayesha N. Khalid MD Abstract Background. Technetium 99m sestamibi scans have become a principal means of localizing parathyroid adenomas. Its accuracy and reliability has allowed for the proliferation of minimal access parathyroidectomy. Localizing interpretation of these scans often drives referral of hyperparathyroid patients for surgery. Interpretation of these scans may differ between nuclear medicine physicians and surgeons. Methods. We reviewed patients (N = 65) with digital images from an academic medical center with the diagnosis of primary hyperparathyroidism. We assessed the willingness to define an adenoma's location, the interrater reliability, and the accuracy of technetium (Tc-99m) sestamibi read by a surgeon and a nuclear medicine physician. Results. There was poor correlation between both readers for assessment of quality of images (k = 0.54, 0.07) but very good correlation for adenoma location (k = 0.81). Conclusion. Both readers had good accuracy in predicting the location of the parathyroid adenoma. The surgeon was more likely to call a scan positive. © 2008 Wiley Periodicals, Inc. Head Neck, 2009 [source] Accuracy of technetium-99m SPECT-CT hybrid images in predicting the precise intraoperative anatomical location of parathyroid adenomasHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2008Luke Harris MD Abstract Background. This study evaluated the accuracy of single photon emission computed tomography (SPECT)-CT imaging for the preoperative localization of parathyroid adenomas. Methods. This study included both a quantitative and qualitative accuracy measure. The quantitative measure was the distance between the location of the adenoma on the SPECT-CT scan and the location of the adenoma intraoperatively. Qualitatively, surgeons were asked whether or not the adenoma was in the exact location predicted by the SPECT-CT scan. The time from initial incision to identification of the parathyroid was recorded. Patients referred to London Health Sciences Centre for a suspected parathyroid adenoma were eligible for this study. Results. Twenty-three patients participated in this study. Eighteen (78.3%) had a single adenoma, 2 (8.7%) had double adenomas, and 3 (13.0%) had multiglandular hyperplasia. SPECT-CT correctly detected and localized 16 of 18 (88.9%) cases of single parathyroid adenomas. The mean distance between the location of the adenoma on the SPECT-CT scan and the location of the adenoma intraoperatively was 16.3 mm (95% , 19.0 mm). For single adenomas, the median time from skin incision to identification was 14 minutes (range, 8,40 minutes). The preoperative detection and localization of a single focus of sestamibi uptake yielded a parathyroid adenoma in the specified location in 80.0% of cases (95% CI, 97.4,66.5%). Conclusions. SPECT-CT predicted the intraoperative location of a single parathyroid adenoma within 19.0 mm with 95% confidence. The correct detection and localization of multiglandular disease remains difficult. © 2007 Wiley Periodicals, Inc. Head Neck, 2008 [source] Preoperative evaluation of patients with parathyroid adenoma: Role of high-resolution ultrasonography,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2002David Ulanovski MD Abstract Background Unilateral parathyroid exploration with adenoma removal and identification of a normal parathyroid gland is a controversial surgical approach to the treatment of primary hyperparathyroidism. The aim of this study was to evaluate the ability of high-resolution ultrasonography to localize adenomas preoperatively and to assess the effect of such localization on operative time. Methods One hundred twenty consecutive previously non-operated patients with primary hyperparathyroidism underwent ultrasonography before surgery, which consisted of unilateral neck exploration. The procedure was changed to bilateral exploration when justified by the surgical findings. Results The sensitivity and positive predictive value of the ultrasonographic examinations were 89% and 98%, respectively. These results were obtained regardless of the size of the adenoma. No significant difference was found in the presence of thyroid multinodular disease (p = .2). A positive sonographic examination decreased the operative time to an average of 59 minutes. The average size of the adenomas was 19 mm (range, 4,55 mm). A positive and highly statistically significant correlation was found between adenoma size and both preoperative calcium level (p = .01) and parathyroid hormone level (p = .0001). Conclusions In experienced hands, high-resolution ultrasonography can be a cost-effective means of localizing parathyroid adenomas when unilateral neck exploration is considered the acceptable surgical approach. © 2002 John Wiley & Sons, Inc. Head Neck 24: 1,5, 2002. [source] Preoperative localization of parathyroid adenomas: cost-effective or just costly?INTERNAL MEDICINE JOURNAL, Issue 4 2002F. A. Khafagi No abstract is available for this article. [source] Accurate localization of supernumerary mediastinal parathyroid adenomas by a combination of structural and functional imagingJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2004GC Mackie Summary Reoperation for refractory or recurrent hyperparathyroidism following parathyroidectomy carries the potential for increased morbidity and the possibility of failure to localize and remove the lesion intraoperatively. Reported herein are three cases demonstrating the combined use of sestamibi scintigraphy, CT and MR for accurate localization of mediastinal parathyroid adenomas. [source] MINIMALLY INVASIVE PARATHYROIDECTOMY USING SURGEON-PERFORMED ULTRASOUND AND SESTAMIBIANZ JOURNAL OF SURGERY, Issue 9 2007Subhita Prasannan Background: Surgeon-performed ultrasound (SPU) and 99mTc-sestamibi (SM) scanning can be used alone or in combination in patients with primary hyperparathyroidism to select cases suitable for minimally invasive parathyroidectomy (MIP). The aim of the study was to evaluate SPU and SM and to determine the reliability they provide the surgeon in planning and carrying out MIP. Methods: The study was a prospective analysis of 130 patients with primary hyperparathyroidism who had preoperative localization with SPU and SM at a tertiary referral centre between 2003 and 2006. All ultrasound scans were carried out by one surgeon, followed by correlative sestamibi scan and a further ,on operating table' ultrasound to reassess the lesion and mark the operative site. Selection criteria for MIP were a positive SPU and SM, although a positive SPU or SM allowed the surgeon to focus on the nominated side. SPU and SM localizations were correlated to the operative findings. Results: One hundred and thirty patients underwent both SPU and SM. There were 97 women and 33 men, with a mean age of 59 years. SPU alone identified the abnormal parathyroid in 103 cases (sensitivity 82%; positive predictive value 96.3%). SM alone identified the abnormal gland in 102 cases (sensitivity 79%; positive predictive value 99%). In 88 patients, the SPU and SM were concordant, and 94% had successful MIP. SPU and SM were both negative in 13 patients, and all these patients had bilateral neck exploration. Conclusion: SPU in the hands of an experienced surgeon in association with sestamibi is a reliable tool for the preoperative localization of parathyroid adenomas and facilitates a minimally invasive procedure. [source] Minimally invasive parathyroidectomy for recurrent or persistent hyperparathyroidism using carbon track localizationANZ JOURNAL OF SURGERY, Issue 10 2003Robert J. Kennedy Background: The present study documents the use of carbon tracking to localize parathyroid adenomas in three patients with persistent or recurrent parathyroid disease. Methods: Three patients requiring second or third operations for hyperparathyroidism were operated upon after the parathyroid lesion had been localized preoperatively using a suspension of carbon particles in water. The enlarged parathyroid glands were identified by using one or more of the following: computed axial tomography, magnetic resonance imaging, ultrasound or Sestamibi nuclear scan. The lesion was then localized with ultrasound or computed axial tomography and a carbon track was inserted from the lesion to the skin, leaving a small skin tattoo as a marker for the surgeon. Each patient underwent a minimally invasive parathyroid operation. Results: For each of the three patients the recurrent or persistent parathyroid adenoma was successfully identified and removed via a small incision. Conclusion: Minimally invasive techniques for primary hyperparathyroidism are changing our approach to parathyroid surgery. However, a minimally invasive technique is less applicable when the disease is persistent or recurrent. Although, when the recurrent or persistent parathyroid adenoma can be identified, localization and carbon tracking have proved useful in allowing the surgeon to remove the lesion via a minimally invasive technique. [source] Effect of treatment with depot somatostatin analogue octreotide on primary hyperparathyroidism (PHP) in multiple endocrine neoplasia type 1 (MEN1) patientsCLINICAL ENDOCRINOLOGY, Issue 5 2008Antongiulio Faggiano Summary Background, In patients with multiple endocrine neoplasia type 1 (MEN1), expression of somatostatin receptor (SST) in parathyroid adenomas and effectiveness of therapy with somatostatin analogues on primary hyperparathyroidism (PHP) have been scarcely investigated. Objective, To evaluate the effects of depot long acting octreotide (OCT-LAR) in patients with MEN1-related PHP. Patients, Eight patients with a genetically confirmed MEN1, presenting both PHP and duodeno-pancreatic neuroendocrine tumours (NET), were enrolled. Design, The initial treatment was OCT-LAR 30 mg every 4 weeks. This therapy was established to stabilize the duodeno-pancreatic NET before to perform parathyroidectomy for PHP. Before OCT-LAR therapy, a SST scintigraphy was performed in all patients. SST subtype 2A immunohistochemistry was performed on parathyroid tumour samples from three patients undergone parathyroidectomy after OCT-LAR therapy. Measurements, Serum concentrations of PTH, calcium and phosphorus as well as the 24-h urine calcium : creatinine ratio and the renal threshold phosphate concentration were evaluated before and after OCT-LAR. Results, After OCT-LAR therapy, hypercalcaemia and hypercalciuria normalized in 75% and 62·5% of patients, respectively, and serum phosphorus and renal threshold phosphate significantly increased. Serum PTH concentrations significantly decreased in all patients and normalized in two of them. SST subtype 2A immunostaining was found in all parathyroid adenomas investigated, while SST scintigraphy showed a positive parathyroid tumour uptake in three of eight patients (37·5%). Conclusion, Six months of OCT-LAR therapy controlled hypercalcaemia and hypercalciuria in two-thirds of patients with MEN1-related PHP. Direct OCT-LAR effects mediated by binding to SST expression on parathyroid tumour cells are likely the main mechanism to explain the activity of this compound on calcium and phosphorus abnormalities in MEN1 PHP. [source] Preoperative localization of parathyroid adenomas: ultrasonography, sestamibi scintigraphy, or both?CLINICAL OTOLARYNGOLOGY, Issue 5 2004D. Hajioff Minimal access techniques are increasingly used to remove parathyroid adenomas. Such surgery depends on accurate preoperative localization but the selection of imaging modality remains controversial. We have reviewed the accuracy of ultrasonography, sestamibi scintigraphy and their combination in 48 cases of primary hyperparathyroidism. Ultrasound had a sensitivity of 64.3% (95% confidence interval 44.1,81.4) and positive predictive value (PPV) of 100% (81.5,100) for correct lateralization. Sestamibi had a sensitivity of 83.3% (69.8,92.5) and PPV of 87.1% (73.7,95.1). The simple combination of ultrasound with sestamibi had a sensitivity of 82.1% (63.1,93.9) and a PPV of 92.0% (74.0,99.0): little different from sestamibi alone. However, if the sestamibi result was disregarded in favour of ultrasonography in discordant cases, the sensitivity reached 96.4% (81.7,99.9) and the PPV was 100% (87.2,100). These results were not dependant on a learning curve or the size of adenoma. [source] | |||||||||||||||||||||||||