Subscribe to RSS
DOI: 10.1055/s-0042-113613
Selective Venous Blood Sampling for Hyperparathyroidism with unclear Localization of the Parathyroid Gland
Selektives Venenblutsampling bei Hyperparathyreoidismus mit unklarer NebenschilddrüsenlokalisationPublication History
12 January 2016
04 July 2016
Publication Date:
19 September 2016 (online)
![](https://www.thieme-connect.de/media/roefo/201612/lookinside/thumbnails/roefo-2627en_10-1055-s-0042-113613-1.jpg)
Abstract
Purpose: Evaluation of the benefit of selective venous blood sampling (SVS) for the preoperative identification of parathyroid adenomas with unclear localization in non-invasive diagnostics.
Materials and Methods: In a retrospective study, all patients (n = 23) with primary (n = 21) or tertiary (n = 2) hyperparathyroidism were evaluated from 2005 to 2016 at the Hospital Nuremberg-North. These patients all received one (n = 20) or more (n = 3) SVS. 15 patients had one or more previous unsuccessful surgeries (group A), 8 patients received the SVS primarily before the first surgery (group B). Results of SVS were compared with the results of surgery, non-invasive diagnostic procedures and clinical follow up.
Results: In 24 out of 26 SVS a significant PTH peak was found. 19 patients underwent surgery after SVS. In 16 of these cases (84 %) the SVS peak was concordant with the intraoperative localization. Thus, SVS of all operated patients had a sensitivity of 94 %. Considering only patients with prior HPT surgery the sensitivity was 89 %. In none of the 26 examinations complications occurred.
Conclusion: Our results demonstrate that selective venous blood sampling SVS in cases with unclear imaging of parathyroid adenomas is an effective and low-risk invasive diagnostic method to localize parathyroid adenomas and helps to improve surgical therapy.
Key points:
• low risk invasive diagnostic procedure to localize parathyroid adenomas
• additional step if non-invasive diagnostics are negative or inconclusive
• high sensitivity in the detection of parathyroid adenomas
Citation Format:
• Hader C, Uder M, Loose RWR et al. Selective Venous Blood Sampling for Hyperparathyroidism with unclear Localization of the Parathyroid Gland. Fortschr Röntgenstr 2016; 188: 1144 – 1150
Zusammenfassung
Ziel: Bewertung des Nutzens des selektiven Venenblutsamplings (SVS) zur präoperativen Identifikation von Nebenschilddrüsenadenomen bei unklarer Lokalisation in der nichtinvasiven Diagnostik.
Material und Methoden: In einer retrospektiven Studie wurden alle Patienten (n = 23) mit primärem (n = 21) oder tertiärem (n = 2) Hyperparathyreoidismus (HPT) untersucht, die im Zeitraum von 2005 bis 2016 am Klinikum Nürnberg-Nord eine (n = 20) oder mehrere (n = 3) SVS erhalten haben. 15 Patienten waren bereits ein- oder mehrmals erfolglos operiert worden (Gruppe A), 8 erhielten die SVS primär vor der Erstoperation (Gruppe B). Die Resultate der SVS wurden anhand der Operationsergebnisse, der histologischen Befunde sowie des klinischen Verlaufs evaluiert.
Ergebnisse: 24 der 26 durchgeführten SVS zeigten einen signifikanten PTH-Peak. 19 Patienten wurden nach Durchführung der SVS operiert. Davon war die SVS in 16 Fällen (84 %) konkordant zur intraoperativen Lokalisation. Somit hatte die SVS für alle operierten Patienten eine Sensitivität von 94 %, bezüglich der Patienten mit HPT-Voroperation allein ergab sich eine Sensitivität von 89 %. Bei keiner der 26 Untersuchungen traten Komplikationen auf.
Schlussfolgerung: Unsere Ergebnisse zeigen, dass die SVS bei unklarer nichtinvasiver Bildgebung von Nebenschilddrüsenadenomen ein effektives und risikoarmes invasives diagnostisches Verfahren darstellt, um Nebenschilddrüsenadenome zu lokalisieren und so den Erfolg der chirurgischen Therapie des HPT zu verbessern.
-
References
- 1 Pallan S, Rahman MO, Khan AA. Diagnosis and management of primary hyperparathyroidism. BMJ 2012; DOI: 10.1136/bmj.e1013.
- 2 Gasser RW. Clinical aspects of primary hyperparathyroidism: clinical manifestations, diagnosis, and therapy. Med Wochenschr 2013; 163: 397-402 DOI: 10.1007/s10354-013-0235-z.
- 3 Suliburk JW, Perrier ND. Primary Hyperparathroidism. The Oncologist 2007; 12: 644-653 DOI: 10.1634/theoncologist.12-6-644.
- 4 Karakas E, Schneider R, Rothmund M et al. Initial Surgery for Benign Primary Hyperparathyroidism: An Analysis of 1300 Patients in a Teaching Hospital. World J Surg 2014; 38: 2011-2018 DOI: 10.1007/s00268-014-2520-4.
- 5 Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 2002; 235: 665-670
- 6 Kuo LE, Wachtel H, Fraker D et al. Reoperative parathyroidectomy: who is at risk and what is the risk?. J Surg Res 2014; 191: 256-261 DOI: 10.1016/j.jss.2014.05.073.
- 7 Siewert JR, Rothmund M, Schumpelick V (eds). Endokrine Chirurgie. Heidelberg: Springer; 2013: 266
- 8 Karakas E, Müller HH, Schlosshauer T et al. Reoperations for primary hyperparathyroidism – improvement of outcome over two decades. Langenbecks Arch Surg 2013; 398: 99-106 DOI: 10.1007/s00423-012-1004-y.
- 9 Mauro MA, Murphy KPJ, Thomson KR et al. (eds). Image-Guided Interventions. Philadelphia: Saunders Elsevier; 2014: 814
- 10 Huppert BJ, Reading CC. Parathyroid sonography: imaging and intervention. J Clin Ultrasound 2007; 35: 144-155
- 11 Mohebati A, Shaha AR. Imaging techniques in parathyroid surgery for primary hyperparathyroidism. Am J Otolaryngol 2012; 33: 457-468 DOI: 10.1016/j.amjoto.2011.10.010.
- 12 Solbiati L, Osti V, Cova L et al. Ultrasound of thyroid, parathyroid glands and neck lymph nodes. Eur Radiol 2001; 11: 2411-2424 DOI: 10.1007/s00330-001-1163-76718936.
- 13 Kunstman JW, Kirsch JD, Mahajan A et al. Clinical review: Parathyroid lokcalization and implications for clinical management. J Clin Endocrinol Metab 2013; 98: 902-912 DOI: 10.1210/jc.2012-3168.
- 14 Mihai R, Simon D, Hellmann P. Imaging for primary hyperparathyroidism – an evidence-based analysis. Langenbecks Arch Surg 2009; 394: 765-784 DOI: 10.1007/s00423-009-0534-4.
- 15 Reidel MA, Schilling T, Graf S et al. Localization of hyperfunctioning parathyroid glands by selective venous sampling in reoperation for primary or secondary hyperparathyroidism. Surgery 2006; 140: 907-913 DOI: 10.1016/j.surg.2006.06.037.
- 16 Jones JJ, Brunaud L, Dowd CF et al. Accuracy of selective venous sampling for intact parathyroid hormone in difficult patients with recurrent or persistent hyperparathyroidism. Surgery 2002; 132: 944-950 DOI: 10.1067/msy.2002.128477.
- 17 Liew V, Gough IR, Nolan G et al. Re-operation for hyperparathyroidism. ANZ J Surg 2004; 74: 732-740 DOI: 10.1111/j.1445-1433.2004.03142.x.
- 18 Hessman O, Stalberg P, Sundin A et al. High success rate of parathyroid reoperation may be achieved with improved localization diagnosis. World J Surg 2008; 32: 774-781 DOI: 10.1007/s00268-008-9537-5.
- 19 Eloy JA, Mitty H, Genden EM. Preoperative selective venous sampling for nonlocalizing parathyroid adenomas. Thyroid 2006; 16: 787-790 DOI: 10.1089/thy.2006.16.787.
- 20 Nawrot I, Chudzinski W, Ciaćka T et al. 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 DOI: 10.12659/MSM.890983.
- 21 Rodgers SE, Lew JJ, Solórzano CC. Primary hyperparathyroidism. Curr Opin Oncol 2008; 20: 52-58 DOI: 10.1097/CCO.0b013e3282f2838f.