Preoperative localisation for parathyroid surgery in primary hyperthyroidism

a study to evaluate the clinical utility of different imaging modalities

Khyatisha Seejore, John Stephenson, E Tun, D Martin-Hirsch, K Al-Zwae, Rob Moisey

Research output: Contribution to journalArticle

Abstract

Background: Primary hyperparathyroidism (PHPT) is caused by a solitary benign adenoma in 80–85% of cases, but may also be due to multi-gland or ectopic disease, hyperplasia, and rarely parathyroid carcinoma. Preoperative localisation studies are important to identify patients suitable for minimally invasive parathyroid surgery. The aim of this study was to evaluate the accuracy of ultrasound (US), parathyroid scintigraphy (MIBI) and computed tomography (CT) utilised in the preoperative setting in a district general hospital, with limited access to single photon-emission computed tomography (SPECT).

Methods: A retrospective study of 88 consecutive patients, who underwent parathyroidectomy for PHPT at a single unit between 2010 and 2014, was conducted. Patients were identified using discharge codes from locally held coding data. The sensitivity and specificity of each imaging modality was compared against histology as the gold standard.

Results: Eithty-two (93%) patients were first presentations of PHPT and six (7%) were relapses, requiring remedial surgery. At surgery, a solitary adenoma was identified in 72 (82%) patients, eight (9%) had parathyroid hyperplasia and one (1%) had parathyroid carcinoma. Preoperatively 100% of patients had US, 82 (93%) MIBI and 67 (59%) CT. Three (3%) had single image modality, 30 (34%) had two and 43 (49%) had three imaging modalities. 43 (53%) parathyroid adenomas were identified with US, 39 (52%) with MIBI and 31 (67%) with CT. Combined US/MIBI were carried out in 82 patients, yielding a sensitivity of 63%. Paired US/CT had a sensitivity of 75% in 52 patients. 21 patients (24%) with inconclusive imaging were referred to tertiary centres for SPECT which successfully identified ten patients. Thirteen patients (15%) underwent neck exploration due to failure of localisation studies. An overall cure rate of 92% was achieved.

Conclusion: Combined US/CT is superior for accurate preoperative localisation of solitary parathyroid adenomas over any single or combination imaging modality.
Original languageEnglish
Pages (from-to)55-55
Number of pages1
JournalEndocrine Abstracts
Volume44
DOIs
Publication statusPublished - 1 Nov 2016

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Hyperthyroidism
Parathyroid Neoplasms
Tomography
Primary Hyperparathyroidism
Single-Photon Emission-Computed Tomography
Adenoma
Hyperplasia
Parathyroidectomy
Minimally Invasive Surgical Procedures
District Hospitals
General Hospitals
Radionuclide Imaging
Histology
Neck
Retrospective Studies
Recurrence
Sensitivity and Specificity

Cite this

@article{02e58f04461e43bfaa9809aca1a9f5ca,
title = "Preoperative localisation for parathyroid surgery in primary hyperthyroidism: a study to evaluate the clinical utility of different imaging modalities",
abstract = "Background: Primary hyperparathyroidism (PHPT) is caused by a solitary benign adenoma in 80–85{\%} of cases, but may also be due to multi-gland or ectopic disease, hyperplasia, and rarely parathyroid carcinoma. Preoperative localisation studies are important to identify patients suitable for minimally invasive parathyroid surgery. The aim of this study was to evaluate the accuracy of ultrasound (US), parathyroid scintigraphy (MIBI) and computed tomography (CT) utilised in the preoperative setting in a district general hospital, with limited access to single photon-emission computed tomography (SPECT).Methods: A retrospective study of 88 consecutive patients, who underwent parathyroidectomy for PHPT at a single unit between 2010 and 2014, was conducted. Patients were identified using discharge codes from locally held coding data. The sensitivity and specificity of each imaging modality was compared against histology as the gold standard.Results: Eithty-two (93{\%}) patients were first presentations of PHPT and six (7{\%}) were relapses, requiring remedial surgery. At surgery, a solitary adenoma was identified in 72 (82{\%}) patients, eight (9{\%}) had parathyroid hyperplasia and one (1{\%}) had parathyroid carcinoma. Preoperatively 100{\%} of patients had US, 82 (93{\%}) MIBI and 67 (59{\%}) CT. Three (3{\%}) had single image modality, 30 (34{\%}) had two and 43 (49{\%}) had three imaging modalities. 43 (53{\%}) parathyroid adenomas were identified with US, 39 (52{\%}) with MIBI and 31 (67{\%}) with CT. Combined US/MIBI were carried out in 82 patients, yielding a sensitivity of 63{\%}. Paired US/CT had a sensitivity of 75{\%} in 52 patients. 21 patients (24{\%}) with inconclusive imaging were referred to tertiary centres for SPECT which successfully identified ten patients. Thirteen patients (15{\%}) underwent neck exploration due to failure of localisation studies. An overall cure rate of 92{\%} was achieved.Conclusion: Combined US/CT is superior for accurate preoperative localisation of solitary parathyroid adenomas over any single or combination imaging modality.",
author = "Khyatisha Seejore and John Stephenson and E Tun and D Martin-Hirsch and K Al-Zwae and Rob Moisey",
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Preoperative localisation for parathyroid surgery in primary hyperthyroidism : a study to evaluate the clinical utility of different imaging modalities. / Seejore, Khyatisha; Stephenson, John; Tun, E; Martin-Hirsch, D; Al-Zwae, K; Moisey, Rob.

In: Endocrine Abstracts, Vol. 44, 01.11.2016, p. 55-55.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Preoperative localisation for parathyroid surgery in primary hyperthyroidism

T2 - a study to evaluate the clinical utility of different imaging modalities

AU - Seejore, Khyatisha

AU - Stephenson, John

AU - Tun, E

AU - Martin-Hirsch, D

AU - Al-Zwae, K

AU - Moisey, Rob

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Background: Primary hyperparathyroidism (PHPT) is caused by a solitary benign adenoma in 80–85% of cases, but may also be due to multi-gland or ectopic disease, hyperplasia, and rarely parathyroid carcinoma. Preoperative localisation studies are important to identify patients suitable for minimally invasive parathyroid surgery. The aim of this study was to evaluate the accuracy of ultrasound (US), parathyroid scintigraphy (MIBI) and computed tomography (CT) utilised in the preoperative setting in a district general hospital, with limited access to single photon-emission computed tomography (SPECT).Methods: A retrospective study of 88 consecutive patients, who underwent parathyroidectomy for PHPT at a single unit between 2010 and 2014, was conducted. Patients were identified using discharge codes from locally held coding data. The sensitivity and specificity of each imaging modality was compared against histology as the gold standard.Results: Eithty-two (93%) patients were first presentations of PHPT and six (7%) were relapses, requiring remedial surgery. At surgery, a solitary adenoma was identified in 72 (82%) patients, eight (9%) had parathyroid hyperplasia and one (1%) had parathyroid carcinoma. Preoperatively 100% of patients had US, 82 (93%) MIBI and 67 (59%) CT. Three (3%) had single image modality, 30 (34%) had two and 43 (49%) had three imaging modalities. 43 (53%) parathyroid adenomas were identified with US, 39 (52%) with MIBI and 31 (67%) with CT. Combined US/MIBI were carried out in 82 patients, yielding a sensitivity of 63%. Paired US/CT had a sensitivity of 75% in 52 patients. 21 patients (24%) with inconclusive imaging were referred to tertiary centres for SPECT which successfully identified ten patients. Thirteen patients (15%) underwent neck exploration due to failure of localisation studies. An overall cure rate of 92% was achieved.Conclusion: Combined US/CT is superior for accurate preoperative localisation of solitary parathyroid adenomas over any single or combination imaging modality.

AB - Background: Primary hyperparathyroidism (PHPT) is caused by a solitary benign adenoma in 80–85% of cases, but may also be due to multi-gland or ectopic disease, hyperplasia, and rarely parathyroid carcinoma. Preoperative localisation studies are important to identify patients suitable for minimally invasive parathyroid surgery. The aim of this study was to evaluate the accuracy of ultrasound (US), parathyroid scintigraphy (MIBI) and computed tomography (CT) utilised in the preoperative setting in a district general hospital, with limited access to single photon-emission computed tomography (SPECT).Methods: A retrospective study of 88 consecutive patients, who underwent parathyroidectomy for PHPT at a single unit between 2010 and 2014, was conducted. Patients were identified using discharge codes from locally held coding data. The sensitivity and specificity of each imaging modality was compared against histology as the gold standard.Results: Eithty-two (93%) patients were first presentations of PHPT and six (7%) were relapses, requiring remedial surgery. At surgery, a solitary adenoma was identified in 72 (82%) patients, eight (9%) had parathyroid hyperplasia and one (1%) had parathyroid carcinoma. Preoperatively 100% of patients had US, 82 (93%) MIBI and 67 (59%) CT. Three (3%) had single image modality, 30 (34%) had two and 43 (49%) had three imaging modalities. 43 (53%) parathyroid adenomas were identified with US, 39 (52%) with MIBI and 31 (67%) with CT. Combined US/MIBI were carried out in 82 patients, yielding a sensitivity of 63%. Paired US/CT had a sensitivity of 75% in 52 patients. 21 patients (24%) with inconclusive imaging were referred to tertiary centres for SPECT which successfully identified ten patients. Thirteen patients (15%) underwent neck exploration due to failure of localisation studies. An overall cure rate of 92% was achieved.Conclusion: Combined US/CT is superior for accurate preoperative localisation of solitary parathyroid adenomas over any single or combination imaging modality.

U2 - 10.1530/endoabs.44.P55

DO - 10.1530/endoabs.44.P55

M3 - Article

VL - 44

SP - 55

EP - 55

JO - Endocrine Abstracts

JF - Endocrine Abstracts

SN - 1470-3947

ER -