Philip Y Sun1, Scott M Thompson2, James C Andrews2, Robert A Wermers3, Travis J McKenzie4, Melanie L Richards4, David R Farley4, Geoffrey B Thompson5. 1. Mayo Medical School, College of Medicine, Mayo Clinic 200 1st St SW, Rochester, MN, 55905, USA. 2. Department of Radiology, College of Medicine, Mayo Clinic 200 1st St SW, Rochester, MN, 55905, USA. 3. Division of Diabetes, Endocrinology and Metabolism, College of Medicine, Mayo Clinic 200 1st St SW, Rochester, MN, 55905, USA. 4. Department of Surgery, College of Medicine, Mayo Clinic 200 1st St SW, Rochester, MN, 55905, USA. 5. Department of Surgery, College of Medicine, Mayo Clinic 200 1st St SW, Rochester, MN, 55905, USA. thompson.geoffrey@mayo.edu.
Abstract
BACKGROUND: In patients with persistent (P-PHPT) or recurrent (R-PHPT) primary hyperparathyroidism, preoperative localization is important. Selective parathyroid hormone venous sampling (sPVS) is an invasive technique that can be used to regionalize and/or lateralize the source of PHPT when noninvasive imaging studies are nonlocalizing. The aim of the present study was to assess the role of sPVS in the preoperative evaluation of patients with P-PHPT or R-PHPT and negative, equivocal, or discordant noninvasive imaging localization. METHODS: After IRB-approval a retrospective review of all patients with P-PHPT or R-PHPT and nonlocalizing noninvasive imaging that underwent sPVS from 2000 to 2014 was performed. The location of the source of PHPT at sPVS was predicted by a parathyroid hormone (PTH) gradient and compared to the surgical, pathology, and biochemical follow-up data as the gold standard. Sensitivity and positive predictive value (PPV) were calculated. RESULTS: Of 30 patients who underwent sPVS, 12 patients did not undergo surgical exploration due to negative or non-localizing PTH gradient (n = 8) or opted for medical management (n = 4). Of the 18 patients who underwent surgical exploration, 17 (94 %) had a positive PTH gradient and pathologic parathyroid tissue identified at surgery. Sensitivity and PPV of sPVS were 93 and 77 %, respectively, for all surgical cases, 86 and 60.0 % for cervical cases (n = 11), and 100 and 100 % for mediastinal cases (n = 7). Sixteen patients (89 %) were surgically cured. CONCLUSIONS: In patients with P-PHPT or R-PHPT and nonlocalizing imaging studies, sPVS is a sensitive test for localizing the source of PHPT when a positive PTH gradient is present.
BACKGROUND: In patients with persistent (P-PHPT) or recurrent (R-PHPT) primary hyperparathyroidism, preoperative localization is important. Selective parathyroid hormone venous sampling (sPVS) is an invasive technique that can be used to regionalize and/or lateralize the source of PHPT when noninvasive imaging studies are nonlocalizing. The aim of the present study was to assess the role of sPVS in the preoperative evaluation of patients with P-PHPT or R-PHPT and negative, equivocal, or discordant noninvasive imaging localization. METHODS: After IRB-approval a retrospective review of all patients with P-PHPT or R-PHPT and nonlocalizing noninvasive imaging that underwent sPVS from 2000 to 2014 was performed. The location of the source of PHPT at sPVS was predicted by a parathyroid hormone (PTH) gradient and compared to the surgical, pathology, and biochemical follow-up data as the gold standard. Sensitivity and positive predictive value (PPV) were calculated. RESULTS: Of 30 patients who underwent sPVS, 12 patients did not undergo surgical exploration due to negative or non-localizing PTH gradient (n = 8) or opted for medical management (n = 4). Of the 18 patients who underwent surgical exploration, 17 (94 %) had a positive PTH gradient and pathologic parathyroid tissue identified at surgery. Sensitivity and PPV of sPVS were 93 and 77 %, respectively, for all surgical cases, 86 and 60.0 % for cervical cases (n = 11), and 100 and 100 % for mediastinal cases (n = 7). Sixteen patients (89 %) were surgically cured. CONCLUSIONS: In patients with P-PHPT or R-PHPT and nonlocalizing imaging studies, sPVS is a sensitive test for localizing the source of PHPT when a positive PTH gradient is present.
Authors: Irina Bancos; Clive S Grant; Sarah Nadeem; Marius N Stan; Carl C Reading; Thomas J Sebo; Alicia Algeciras-Schimnich; Ravinder J Singh; Diana S Dean Journal: Endocr Pract Date: 2012 Jul-Aug Impact factor: 3.443
Authors: Christina Lenschow; Peter Gassmann; Christian Wenning; Norbert Senninger; Mario Colombo-Benkmann Journal: World J Surg Date: 2015-07 Impact factor: 3.352
Authors: Janneke E Witteveen; Job Kievit; Arian R van Erkel; Hans Morreau; Johannes A Romijn; Neveen A T Hamdy Journal: Eur J Endocrinol Date: 2010-09-24 Impact factor: 6.664
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Tatjana Traub-Weidinger; Marius E Mayerhoefer; Oskar Koperek; Markus Mitterhauser; Heying Duan; Georgios Karanikas; Bruno Niederle; Martha Hoffmann Journal: J Clin Endocrinol Metab Date: 2014-07-16 Impact factor: 5.958
Authors: Michael Ginsburg; Gregory A Christoforidis; Sean P Zivin; Piotr Obara; Kristen Wroblewski; Peter Angelos; Raymon H Grogan; Edwin L Kaplan Journal: J Vasc Interv Radiol Date: 2014-11-14 Impact factor: 3.464
Authors: Robert Udelsman; John E Aruny; Patricia I Donovan; Lori J Sokoll; Florie Santos; Richard Donabedian; Anthony C Venbrux Journal: Ann Surg Date: 2003-05 Impact factor: 12.969
Authors: Anne Hendricks; Christina Lenschow; Matthias Kroiss; Andreas Buck; Ralph Kickuth; Christoph-Thomas Germer; Nicolas Schlegel Journal: Langenbecks Arch Surg Date: 2021-05-16 Impact factor: 3.445