USE OF DIFFERENT IMAGING MODALITIES FOR PRE OPERATIVE LOCALIZATION IN SYMPTOMATIC PRIMARY HYPERPARATHYROIDISM
AACE ePoster Library. Karunasena N. 05/13/15; 97764; 518
Dr. Nayananjani Karunasena
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Abstract
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Background: Primary hyperparathyroidism (PHPT) is commonly caused by parathyroid adenoma. Since the adoption of minimally invasive parathyroid surgery accurate preoperative localization has become paramount in investigating PHPT.
Method: A retrospective case note analysis of 15 patients with symptomatic PHPT who underwent parathyroid resection in a single center from 2011-2014. Following biochemical diagnosis of PHPT, they underwent imaging with Ultrasonography (US), Computed tomography (CT) and TC99 Sestamibi scan for preoperative localization. Histology was reviewed and correlated with the radiological and surgical diagnosis. Statistical analysis was done using SPSS version 22 and 2×2 tables.
Results: Among the 15 patients 10 (66.6%) were females and 5 (33.3%) were males. Mean age at presentation was 47±12.5 years. Commonest clinical presentation was nephrolithiasis, which occurred in 7 patients (46.7%). PHPT was confirmed biochemically with elevated total calcium (mean 3.02±0.45 mmol/L) and parathyroid hormone (PTH). Mean PTH was 758±655 pg/mL. Preoperative localization with imaging favored single gland disease in 14 (93.3%) patients and multi-gland disease in one (6.66%) patient. All 3 imaging scans showed concordant results in 6 (40%) patients and 5 (26.6%) patients had two concordant imaging. Only one out of the three imaging was positive in 4 (33.3%) patients. Three patients underwent three and half gland removal while 12 underwent single gland removal. Histology confirmed multigland disease due to hyperplasia in one patient who underwent three and half gland removal and 13 patients had single parathyroid adenoma. One patient was confirmed with parathyroid carcinoma by histology.
Discussion: In this series CT neck had the highest sensitivity, which was 92% while Tc99 Sestamibi had a sensitivity of 83%. US neck had the lowest sensitivity, which was 75%. When US had combined with CT neck or Tc99Sestamibi scan this increased to 88% in both instances. Specificity was not calculated since there was no control group and none of the histology was normal.
Conclusions: According to our series US has a lower sensitivity in detecting parathyroid gland abnormality compared to CT and Tc99 Sestamibi. However, this is an operator dependent test. Since none of the imaging is 100% sensitive combining at least two tests can ensure accurate preoperative localization. Although many experts prefer Tc99 Sestamibi combined with US neck, combination of US with CT neck also has similar sensitivity and can be used specially in resource poor setting, which will facilitate minimally invasive surgery.
Method: A retrospective case note analysis of 15 patients with symptomatic PHPT who underwent parathyroid resection in a single center from 2011-2014. Following biochemical diagnosis of PHPT, they underwent imaging with Ultrasonography (US), Computed tomography (CT) and TC99 Sestamibi scan for preoperative localization. Histology was reviewed and correlated with the radiological and surgical diagnosis. Statistical analysis was done using SPSS version 22 and 2×2 tables.
Results: Among the 15 patients 10 (66.6%) were females and 5 (33.3%) were males. Mean age at presentation was 47±12.5 years. Commonest clinical presentation was nephrolithiasis, which occurred in 7 patients (46.7%). PHPT was confirmed biochemically with elevated total calcium (mean 3.02±0.45 mmol/L) and parathyroid hormone (PTH). Mean PTH was 758±655 pg/mL. Preoperative localization with imaging favored single gland disease in 14 (93.3%) patients and multi-gland disease in one (6.66%) patient. All 3 imaging scans showed concordant results in 6 (40%) patients and 5 (26.6%) patients had two concordant imaging. Only one out of the three imaging was positive in 4 (33.3%) patients. Three patients underwent three and half gland removal while 12 underwent single gland removal. Histology confirmed multigland disease due to hyperplasia in one patient who underwent three and half gland removal and 13 patients had single parathyroid adenoma. One patient was confirmed with parathyroid carcinoma by histology.
Discussion: In this series CT neck had the highest sensitivity, which was 92% while Tc99 Sestamibi had a sensitivity of 83%. US neck had the lowest sensitivity, which was 75%. When US had combined with CT neck or Tc99Sestamibi scan this increased to 88% in both instances. Specificity was not calculated since there was no control group and none of the histology was normal.
Conclusions: According to our series US has a lower sensitivity in detecting parathyroid gland abnormality compared to CT and Tc99 Sestamibi. However, this is an operator dependent test. Since none of the imaging is 100% sensitive combining at least two tests can ensure accurate preoperative localization. Although many experts prefer Tc99 Sestamibi combined with US neck, combination of US with CT neck also has similar sensitivity and can be used specially in resource poor setting, which will facilitate minimally invasive surgery.
Background: Primary hyperparathyroidism (PHPT) is commonly caused by parathyroid adenoma. Since the adoption of minimally invasive parathyroid surgery accurate preoperative localization has become paramount in investigating PHPT.
Method: A retrospective case note analysis of 15 patients with symptomatic PHPT who underwent parathyroid resection in a single center from 2011-2014. Following biochemical diagnosis of PHPT, they underwent imaging with Ultrasonography (US), Computed tomography (CT) and TC99 Sestamibi scan for preoperative localization. Histology was reviewed and correlated with the radiological and surgical diagnosis. Statistical analysis was done using SPSS version 22 and 2×2 tables.
Results: Among the 15 patients 10 (66.6%) were females and 5 (33.3%) were males. Mean age at presentation was 47±12.5 years. Commonest clinical presentation was nephrolithiasis, which occurred in 7 patients (46.7%). PHPT was confirmed biochemically with elevated total calcium (mean 3.02±0.45 mmol/L) and parathyroid hormone (PTH). Mean PTH was 758±655 pg/mL. Preoperative localization with imaging favored single gland disease in 14 (93.3%) patients and multi-gland disease in one (6.66%) patient. All 3 imaging scans showed concordant results in 6 (40%) patients and 5 (26.6%) patients had two concordant imaging. Only one out of the three imaging was positive in 4 (33.3%) patients. Three patients underwent three and half gland removal while 12 underwent single gland removal. Histology confirmed multigland disease due to hyperplasia in one patient who underwent three and half gland removal and 13 patients had single parathyroid adenoma. One patient was confirmed with parathyroid carcinoma by histology.
Discussion: In this series CT neck had the highest sensitivity, which was 92% while Tc99 Sestamibi had a sensitivity of 83%. US neck had the lowest sensitivity, which was 75%. When US had combined with CT neck or Tc99Sestamibi scan this increased to 88% in both instances. Specificity was not calculated since there was no control group and none of the histology was normal.
Conclusions: According to our series US has a lower sensitivity in detecting parathyroid gland abnormality compared to CT and Tc99 Sestamibi. However, this is an operator dependent test. Since none of the imaging is 100% sensitive combining at least two tests can ensure accurate preoperative localization. Although many experts prefer Tc99 Sestamibi combined with US neck, combination of US with CT neck also has similar sensitivity and can be used specially in resource poor setting, which will facilitate minimally invasive surgery.
Method: A retrospective case note analysis of 15 patients with symptomatic PHPT who underwent parathyroid resection in a single center from 2011-2014. Following biochemical diagnosis of PHPT, they underwent imaging with Ultrasonography (US), Computed tomography (CT) and TC99 Sestamibi scan for preoperative localization. Histology was reviewed and correlated with the radiological and surgical diagnosis. Statistical analysis was done using SPSS version 22 and 2×2 tables.
Results: Among the 15 patients 10 (66.6%) were females and 5 (33.3%) were males. Mean age at presentation was 47±12.5 years. Commonest clinical presentation was nephrolithiasis, which occurred in 7 patients (46.7%). PHPT was confirmed biochemically with elevated total calcium (mean 3.02±0.45 mmol/L) and parathyroid hormone (PTH). Mean PTH was 758±655 pg/mL. Preoperative localization with imaging favored single gland disease in 14 (93.3%) patients and multi-gland disease in one (6.66%) patient. All 3 imaging scans showed concordant results in 6 (40%) patients and 5 (26.6%) patients had two concordant imaging. Only one out of the three imaging was positive in 4 (33.3%) patients. Three patients underwent three and half gland removal while 12 underwent single gland removal. Histology confirmed multigland disease due to hyperplasia in one patient who underwent three and half gland removal and 13 patients had single parathyroid adenoma. One patient was confirmed with parathyroid carcinoma by histology.
Discussion: In this series CT neck had the highest sensitivity, which was 92% while Tc99 Sestamibi had a sensitivity of 83%. US neck had the lowest sensitivity, which was 75%. When US had combined with CT neck or Tc99Sestamibi scan this increased to 88% in both instances. Specificity was not calculated since there was no control group and none of the histology was normal.
Conclusions: According to our series US has a lower sensitivity in detecting parathyroid gland abnormality compared to CT and Tc99 Sestamibi. However, this is an operator dependent test. Since none of the imaging is 100% sensitive combining at least two tests can ensure accurate preoperative localization. Although many experts prefer Tc99 Sestamibi combined with US neck, combination of US with CT neck also has similar sensitivity and can be used specially in resource poor setting, which will facilitate minimally invasive surgery.
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