Klinik Araştırma
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Use of preoperative ultrasonography adenoma size measurements for accurate localization estimation in parathyroid adenomas

Yıl 2024, Cilt: 5 Sayı: 1, 28 - 35, 30.01.2024
https://doi.org/10.47482/acmr.1325481

Öz

Background: It is known that Primary hyperparathyroidism (pHPT) is the most common cause of hypercalcemia. It is characterized by high serum calcium and parathyroid hormone (PTH) levels. Also, hyperactivity is seen in one or more of the parathyroid glands and preoperative ultrasonography (USG) usually localizes the location of parathyroid adenomas. In this study, the factors that affect the success of parathyroid surgery have been investigated.
Methods: In total, the medical records of 245 patients with pHPT who underwent parathyroidectomy have been reviewed, retrospectively. In order to confirm the location of hyperactive parathyroid gland and the factors that affect the success of laboratory methods have been examined by using imaging techniques.
Results: As a result, false localization is found in 7.8% (19) of the patients. The weight calculated by using the preoperative USG measurements has been approximately similar to the macroscopic weight (p = 0.651). When the preoperative USG results in patients with false localization have been analyzed, it is seen that the lesion diameter was significantly less than 12 mm and the calculated weight was significantly less than 39 g (p = 0.005 and p < 0.001).
Conclusion: It has been concluded that a second-line imaging should be used to obtain an accurate localization in patients with a small lesion suspected of being a parathyroid adenoma on preoperative USG. In addition, an intraoperative PTH (IOPTH) should be used to increase the success rate of the surgery in patients who cannot undergo a second-line imaging.

Kaynakça

  • Silva BC, Cusano NE, Bilezikian JP. Primary hyperparathyroidism. Best Pract Res Clin Endocrinol Metab. 2018;32(5):593-607.
  • Hendricks A, Lenschow C, Kroiss M, Buck A, Kickuth R, Germer C, et al. Evaluation of diagnostic efficacy for localization of parathyroid adenoma in patients with primary hyperparathyroidism undergoing repeat surgery. Langenbecks Arch Surg. 2021 ;406(5):1615-1624.
  • Nawrot I, Chudziński W, Ciąćka T, Barczyński M, Szmidt J. Reoperations for persistent or recurrent primary hyperparathyroidism: results of a retrospective cohort study at a tertiary referral center. Med Sci Monit. 2014; 20: 1604-1612.
  • Lee PK, Jarosek SL, Virnig BA, Evasovich M, Tuttle TM. Trends in the incidence and treatment of parathyroid cancer in the United States. Cancer. 2007;109(9):1736-41.
  • Lenschow C, Schrägle S, Kircher S, Lorenz K, Machens A; NEKAR study group. Clinical presentation, treatment, and outcome of parathyroid carcinoma: Results of the NEKAR retrospective international multicenter study. Ann Surg. 2022;275(2):e479-e487.
  • Tolley N, Garas G, Palazzo F, Prichard A, Chaidas K, Cox J, et al. Longterm prospective evaluation comparing robotic parathyroidectomy with minimally invasive open parathyroidectomy for primary hyperparathyroidism. Head Neck. 2016;38 Suppl 1:E300-6.
  • Venkat R, Kouniavsky G, Tufano RP, Schneider EB, Dackiw AP, Zeiger MA. Long-term outcome in patients with primary hyperparathyroidism who underwent minimally invasive parathyroidectomy. World J Surg. 2012;36(1):55-60.
  • Yeh MW, Wiseman JE, Chu SD, Ituarte PH, Liu IL, Young KL, et al. Population-level predictors of persistent hyperparathyroidism. Surgery. 2011;150(6):1113-9.
  • Singh Ospina NM, Rodriguez-Gutierrez R, Maraka S, Espinosa de Ycaza AE, Jasim S, Castaneda-Guarderas A, et al. Outcomes of parathyroidectomy in patients with primary hyperparathyroidism: A systematic review and meta-analysis. World J Surg. 2016;40(10):2359- 77.
  • Richards ML, Thompson GB, Farley DR, Grant CS. Reoperative parathyroidectomy in 228 patients during the era of minimal-access surgery and intraoperative parathyroid hormone monitoring. Am J Surg. 2008;196(6):937-42; discussion 942-3.
  • Memeh KO, Palacios JE, Khan R, Guerrero MA. Pre-operative localization of parathyroid adenoma: performance of 4D MRI parathyroid protocol. Endocr Pract. 2019 ;25(4):361-365.
  • Bunch PM, Randolph GW, Brooks JA, George V, Cannon J, Kelly HR. Parathyroid 4D CT: What the surgeon wants to know. Radiographics. 2020;40(5):1383-1394.
  • Wong W, Foo FJ, Lau MI, Sarin A, Kiruparan P. Simplified minimally invasive parathyroidectomy: a series of 100 cases and review of the literature. Ann R Coll Surg Engl. 2011;93(4):290-3.
  • Binks M, Burrows D, Littlejohn D. A rural perspective on minimally invasive parathyroidectomy: optimal preoperative imaging and patient outcomes. ANZ J Surg. 2019 ;89(1-2):43-47.
  • Eller M, Dave A, Johnson C, Fingeret AL. Accuracy of 4-Dimensional computed tomography for localization in primary hyperparathyroidism. J Surg Res. 2021;257:15-21.
  • Berber E, Parikh RT, Ballem N, Garner CN, Milas M, Siperstein AE. Factors contributing to negative parathyroid localization: an analysis of 1000 patients. Surgery. 2008;144(1):74-9.
  • Bradley SJ, Knodle KF. Ultrasound based focused neck exploration for primary hyperparathyroidism. Am J Surg. 2017 ;213(3):452-455.
  • Stern S, Tzelnick S, Mizrachi A, Cohen M, Shpitzer T, Bachar G. Accuracy of neck ultrasonography in predicting the size and location of parathyroid adenomas. Otolaryngol Head Neck Surg. 2018;159(6):968-972.
  • Nawrot I, Chudziński W, Ciąćka T, Barczyński M, Szmidt J. Reoperations for persistent or recurrent primary hyperparathyroidism: results of a retrospective cohort study at a tertiary referral center. Med Sci Monit. 2014;20:1604-12.
  • Yeh R, Tay YD, Dercle L, Bandeira L, Parekh MR, Bilezikian JP. A simple formula to estimate parathyroid weight on 4D-CT, predict pathologic weight, and diagnose parathyroid adenoma in patients with primary hyperparathyroidism. Am J Neuroradiol. 2020;41(9):1690-1697.
  • Calva-Cerqueira D, Smith BJ, Hostetler ML, Lal G, Menda Y, O’Dorisio TM, et al. Minimally invasive parathyroidectomy and preoperative MIBI scans: correlation of gland weight and preoperative PTH. J Am Coll Surg. 2007;205(4 Suppl):S38-44.
  • Abdel-Aziz TE, Gleeson F, Sadler G, Mihai R. Dwarfs and giants of parathyroid adenomas-no difference in outcome after parathyroidectomy. J Surg Res. 2019;237:56-60.
  • Neychev VK, Ghanem M, Blackwood SL, Aragon Han P, Fazeli R, Schneider E, et al. Parathyroid surgery can be safely performed in a community hospital by experienced parathyroid surgeons: A retrospective cohort study. Int J Surg. 2016;27:72-76.
  • Kartal A, Çitgez B, Öden S, Yetkin SG, Mihmanlı M, Aygün N, et al. Risk factors in the occurance of persistent primary hyperparathyroidism. Med Bull Sisli Etfal Hosp 2014;48:213–226.
  • Goodsell KE, Ermer JP, Zaheer S, Kelz RR, Fraker DL, Wachtel H. Double adenoma as a cause of primary hyperparathyroidism: Asymmetric hyperplasia or a distinct pathologic entity? Am J Surg. 2021;222(3):483-489.
  • Mazotas IG, Yen TWF, Doffek K, Shaker JL, Carr AA, Evans DB, et al. Persistent/Recurrent primary hyperparathyroidism: Does the number of abnormal glands play a role? J Surg Res. 2020;246:335-341.
  • Ruda JM, Hollenbeak CS, Stack BC Jr. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg. 2005 ;132:359-372.
  • Choi JH, Jayaram A, Bresnahan E, Pletcher E, Steinmetz D, Owen R, et al. The role of surgeon-performed office and preincision ultrasounds in localization of parathyroid adenomas in primary hyperparathyroidism. Endocr Pract. 2022;28(7):660-666.
  • Dy BM, Richards ML, Vazquez BJ, Thompson GB, Farley DR, Grant CS. Primary hyperparathyroidism and negative Tc99 sestamibi imaging: to operate or not? Ann Surg Oncol. 2012;19(7):2272-8.
  • Acar N, Haciyanli M, Coskun M, Erdogan NK, Celik SC, Haciyanli SG, et al. Diagnostic value of four-dimensional computed tomography and four-dimensional magnetic resonance imaging in primary hyperparathyroidism when first-line imaging was inadequate. Ann R Coll Surg Engl. 2020;102(4):294-299.
  • Graves CE, Hope TA, Kim J, Pampaloni MH, Kluijfhout W, Seib CD, et al. Superior sensitivity of 18F-fluorocholine: PET localization in primary hyperparathyroidism. Surgery. 2022;171(1):47-54.
  • Hendricks A, Lenschow C, Kroiss M, Buck A, Kickuth R, Germer CT, et al. Evaluation of diagnostic efficacy for localization of parathyroid adenoma in patients with primary hyperparathyroidism undergoing repeat surgery. Langenbecks Arch Surg. 2021;406(5):1615-1624.
  • Dobrinja C, Santandrea G, Giacca M, Stenner E, Ruscio M, de Manzini N. Effectiveness of Intraoperative Parathyroid Monitoring (ioPTH) in predicting a multiglandular or malignant parathyroid disease. Int J Surg. 2017;41 Suppl 1:S26-S33.
  • Gücek Hacıyanlı S, Acar N, Ballı Ö, Erdoğan N, Hacıyanlı M. Selective venous sampling in primary hyperparathyroidism: Is it worth doing? Turk J Med Sci. 2022;52(1):144-149.
  • Laxague F, Angeramo CA, Armella ED, Valinoti AC, Mezzadri NA, Fernández Vila JM. Preoperative matching studies in the diagnosis of parathyroid adenoma for primary hyperparathyroidism: Can we avoid intraoperative PTH monitoring? Cir Esp (Engl Ed). 2021;99(8):572-577.
  • Stucken EZ, Kutler DI, Moquete R, Kazam E, Kuhel WI. Localization of small parathyroid adenomas using modified 4-dimensional computed tomography/ultrasound. Otolaryngol Head Neck Surg. 2012;146(1):33-9.
  • Riss P, Kaczirek K, Heinz G, Bieglmayer C, Niederle B. A “defined baseline” in PTH monitoring increases surgical success in patients with multiple gland disease. Surgery. 2007;142(3):398-404.
  • Barczyński M, Gołkowski F, Nawrot I. The current status of intraoperative iPTH assay in surgery for primary hyperparathyroidism. Gland Surg. 2015 ;4(1):36-43.
  • Patel KN, Caso R. Intraoperative Parathyroid Hormone Monitoring: Optimal Utilization. Surg Oncol Clin N Am. 2016 ;25:91-101.
Yıl 2024, Cilt: 5 Sayı: 1, 28 - 35, 30.01.2024
https://doi.org/10.47482/acmr.1325481

Öz

Kaynakça

  • Silva BC, Cusano NE, Bilezikian JP. Primary hyperparathyroidism. Best Pract Res Clin Endocrinol Metab. 2018;32(5):593-607.
  • Hendricks A, Lenschow C, Kroiss M, Buck A, Kickuth R, Germer C, et al. Evaluation of diagnostic efficacy for localization of parathyroid adenoma in patients with primary hyperparathyroidism undergoing repeat surgery. Langenbecks Arch Surg. 2021 ;406(5):1615-1624.
  • Nawrot I, Chudziński W, Ciąćka T, Barczyński M, Szmidt J. Reoperations for persistent or recurrent primary hyperparathyroidism: results of a retrospective cohort study at a tertiary referral center. Med Sci Monit. 2014; 20: 1604-1612.
  • Lee PK, Jarosek SL, Virnig BA, Evasovich M, Tuttle TM. Trends in the incidence and treatment of parathyroid cancer in the United States. Cancer. 2007;109(9):1736-41.
  • Lenschow C, Schrägle S, Kircher S, Lorenz K, Machens A; NEKAR study group. Clinical presentation, treatment, and outcome of parathyroid carcinoma: Results of the NEKAR retrospective international multicenter study. Ann Surg. 2022;275(2):e479-e487.
  • Tolley N, Garas G, Palazzo F, Prichard A, Chaidas K, Cox J, et al. Longterm prospective evaluation comparing robotic parathyroidectomy with minimally invasive open parathyroidectomy for primary hyperparathyroidism. Head Neck. 2016;38 Suppl 1:E300-6.
  • Venkat R, Kouniavsky G, Tufano RP, Schneider EB, Dackiw AP, Zeiger MA. Long-term outcome in patients with primary hyperparathyroidism who underwent minimally invasive parathyroidectomy. World J Surg. 2012;36(1):55-60.
  • Yeh MW, Wiseman JE, Chu SD, Ituarte PH, Liu IL, Young KL, et al. Population-level predictors of persistent hyperparathyroidism. Surgery. 2011;150(6):1113-9.
  • Singh Ospina NM, Rodriguez-Gutierrez R, Maraka S, Espinosa de Ycaza AE, Jasim S, Castaneda-Guarderas A, et al. Outcomes of parathyroidectomy in patients with primary hyperparathyroidism: A systematic review and meta-analysis. World J Surg. 2016;40(10):2359- 77.
  • Richards ML, Thompson GB, Farley DR, Grant CS. Reoperative parathyroidectomy in 228 patients during the era of minimal-access surgery and intraoperative parathyroid hormone monitoring. Am J Surg. 2008;196(6):937-42; discussion 942-3.
  • Memeh KO, Palacios JE, Khan R, Guerrero MA. Pre-operative localization of parathyroid adenoma: performance of 4D MRI parathyroid protocol. Endocr Pract. 2019 ;25(4):361-365.
  • Bunch PM, Randolph GW, Brooks JA, George V, Cannon J, Kelly HR. Parathyroid 4D CT: What the surgeon wants to know. Radiographics. 2020;40(5):1383-1394.
  • Wong W, Foo FJ, Lau MI, Sarin A, Kiruparan P. Simplified minimally invasive parathyroidectomy: a series of 100 cases and review of the literature. Ann R Coll Surg Engl. 2011;93(4):290-3.
  • Binks M, Burrows D, Littlejohn D. A rural perspective on minimally invasive parathyroidectomy: optimal preoperative imaging and patient outcomes. ANZ J Surg. 2019 ;89(1-2):43-47.
  • Eller M, Dave A, Johnson C, Fingeret AL. Accuracy of 4-Dimensional computed tomography for localization in primary hyperparathyroidism. J Surg Res. 2021;257:15-21.
  • Berber E, Parikh RT, Ballem N, Garner CN, Milas M, Siperstein AE. Factors contributing to negative parathyroid localization: an analysis of 1000 patients. Surgery. 2008;144(1):74-9.
  • Bradley SJ, Knodle KF. Ultrasound based focused neck exploration for primary hyperparathyroidism. Am J Surg. 2017 ;213(3):452-455.
  • Stern S, Tzelnick S, Mizrachi A, Cohen M, Shpitzer T, Bachar G. Accuracy of neck ultrasonography in predicting the size and location of parathyroid adenomas. Otolaryngol Head Neck Surg. 2018;159(6):968-972.
  • Nawrot I, Chudziński W, Ciąćka T, Barczyński M, Szmidt J. Reoperations for persistent or recurrent primary hyperparathyroidism: results of a retrospective cohort study at a tertiary referral center. Med Sci Monit. 2014;20:1604-12.
  • Yeh R, Tay YD, Dercle L, Bandeira L, Parekh MR, Bilezikian JP. A simple formula to estimate parathyroid weight on 4D-CT, predict pathologic weight, and diagnose parathyroid adenoma in patients with primary hyperparathyroidism. Am J Neuroradiol. 2020;41(9):1690-1697.
  • Calva-Cerqueira D, Smith BJ, Hostetler ML, Lal G, Menda Y, O’Dorisio TM, et al. Minimally invasive parathyroidectomy and preoperative MIBI scans: correlation of gland weight and preoperative PTH. J Am Coll Surg. 2007;205(4 Suppl):S38-44.
  • Abdel-Aziz TE, Gleeson F, Sadler G, Mihai R. Dwarfs and giants of parathyroid adenomas-no difference in outcome after parathyroidectomy. J Surg Res. 2019;237:56-60.
  • Neychev VK, Ghanem M, Blackwood SL, Aragon Han P, Fazeli R, Schneider E, et al. Parathyroid surgery can be safely performed in a community hospital by experienced parathyroid surgeons: A retrospective cohort study. Int J Surg. 2016;27:72-76.
  • Kartal A, Çitgez B, Öden S, Yetkin SG, Mihmanlı M, Aygün N, et al. Risk factors in the occurance of persistent primary hyperparathyroidism. Med Bull Sisli Etfal Hosp 2014;48:213–226.
  • Goodsell KE, Ermer JP, Zaheer S, Kelz RR, Fraker DL, Wachtel H. Double adenoma as a cause of primary hyperparathyroidism: Asymmetric hyperplasia or a distinct pathologic entity? Am J Surg. 2021;222(3):483-489.
  • Mazotas IG, Yen TWF, Doffek K, Shaker JL, Carr AA, Evans DB, et al. Persistent/Recurrent primary hyperparathyroidism: Does the number of abnormal glands play a role? J Surg Res. 2020;246:335-341.
  • Ruda JM, Hollenbeak CS, Stack BC Jr. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg. 2005 ;132:359-372.
  • Choi JH, Jayaram A, Bresnahan E, Pletcher E, Steinmetz D, Owen R, et al. The role of surgeon-performed office and preincision ultrasounds in localization of parathyroid adenomas in primary hyperparathyroidism. Endocr Pract. 2022;28(7):660-666.
  • Dy BM, Richards ML, Vazquez BJ, Thompson GB, Farley DR, Grant CS. Primary hyperparathyroidism and negative Tc99 sestamibi imaging: to operate or not? Ann Surg Oncol. 2012;19(7):2272-8.
  • Acar N, Haciyanli M, Coskun M, Erdogan NK, Celik SC, Haciyanli SG, et al. Diagnostic value of four-dimensional computed tomography and four-dimensional magnetic resonance imaging in primary hyperparathyroidism when first-line imaging was inadequate. Ann R Coll Surg Engl. 2020;102(4):294-299.
  • Graves CE, Hope TA, Kim J, Pampaloni MH, Kluijfhout W, Seib CD, et al. Superior sensitivity of 18F-fluorocholine: PET localization in primary hyperparathyroidism. Surgery. 2022;171(1):47-54.
  • Hendricks A, Lenschow C, Kroiss M, Buck A, Kickuth R, Germer CT, et al. Evaluation of diagnostic efficacy for localization of parathyroid adenoma in patients with primary hyperparathyroidism undergoing repeat surgery. Langenbecks Arch Surg. 2021;406(5):1615-1624.
  • Dobrinja C, Santandrea G, Giacca M, Stenner E, Ruscio M, de Manzini N. Effectiveness of Intraoperative Parathyroid Monitoring (ioPTH) in predicting a multiglandular or malignant parathyroid disease. Int J Surg. 2017;41 Suppl 1:S26-S33.
  • Gücek Hacıyanlı S, Acar N, Ballı Ö, Erdoğan N, Hacıyanlı M. Selective venous sampling in primary hyperparathyroidism: Is it worth doing? Turk J Med Sci. 2022;52(1):144-149.
  • Laxague F, Angeramo CA, Armella ED, Valinoti AC, Mezzadri NA, Fernández Vila JM. Preoperative matching studies in the diagnosis of parathyroid adenoma for primary hyperparathyroidism: Can we avoid intraoperative PTH monitoring? Cir Esp (Engl Ed). 2021;99(8):572-577.
  • Stucken EZ, Kutler DI, Moquete R, Kazam E, Kuhel WI. Localization of small parathyroid adenomas using modified 4-dimensional computed tomography/ultrasound. Otolaryngol Head Neck Surg. 2012;146(1):33-9.
  • Riss P, Kaczirek K, Heinz G, Bieglmayer C, Niederle B. A “defined baseline” in PTH monitoring increases surgical success in patients with multiple gland disease. Surgery. 2007;142(3):398-404.
  • Barczyński M, Gołkowski F, Nawrot I. The current status of intraoperative iPTH assay in surgery for primary hyperparathyroidism. Gland Surg. 2015 ;4(1):36-43.
  • Patel KN, Caso R. Intraoperative Parathyroid Hormone Monitoring: Optimal Utilization. Surg Oncol Clin N Am. 2016 ;25:91-101.

Ayrıntılar

Birincil Dil İngilizce
Konular Genel Cerrahi
Bölüm ORIGINAL ARTICLE
Yazarlar

Servet KOCAÖZ 0000-0002-0085-2380

Mustafa Ömer YAZICIOĞLU 0000-0001-6150-0226

Bülent ÇOMÇALI 0000-0002-2111-1477

Furkan SAVAŞ 0000-0002-3963-7784

Buket ALTUN ÖZDEMİR 0000-0002-1043-8108

Ahmet Melih TAŞBAŞI 0000-0002-5811-0961

Ozlem UNAL 0000-0003-4297-4930

Şevket Barış MORKAVUK 0000-0003-0441-0333

Birol KORUKLUOĞLU 0000-0003-4164-6898

Erken Görünüm Tarihi 30 Ocak 2024
Yayımlanma Tarihi 30 Ocak 2024
Gönderilme Tarihi 10 Temmuz 2023
Yayımlandığı Sayı Yıl 2024 Cilt: 5 Sayı: 1

Kaynak Göster

APA KOCAÖZ, S., YAZICIOĞLU, M. Ö., ÇOMÇALI, B., SAVAŞ, F., vd. (2024). Use of preoperative ultrasonography adenoma size measurements for accurate localization estimation in parathyroid adenomas. Archives of Current Medical Research, 5(1), 28-35. https://doi.org/10.47482/acmr.1325481

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