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Selective venous sampling in primary hyperparathyroidism: Is it worth doing?

Selda Gücek Hacıyanlı1, Nihan Acar1, Ömür Ballı2

  • 1Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey.

Turkish Journal of Medical Sciences
|October 24, 2021
PubMed
Summary

Selective parathyroid venous sampling aids in localizing parathyroid glands when conventional imaging fails for primary hyperparathyroidism. This method achieved 75% sensitivity, improving localization accuracy in complex cases.

Keywords:
4D-CT4D-MRIPersistentparathyroidectomyprimary hyperparathyroidismvenous sampling

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Radiology

Background:

  • Accurate preoperative localization of the parathyroid gland is crucial for successful surgical treatment of primary hyperparathyroidism.
  • Conventional imaging like ultrasound and Tc99m sestamibi scintigraphy are typically sufficient but can fail in certain patient groups.
  • Additional imaging modalities are sometimes necessary when noninvasive techniques are inadequate.

Purpose of the Study:

  • To evaluate the diagnostic value of selective parathyroid venous sampling.
  • To assess its utility in patients with unclear noninvasive localization tests for primary hyperparathyroidism.

Main Methods:

  • Retrospective review of 12 cases (2.3%) out of 513 parathyroidectomies for primary hyperparathyroidism who underwent selective parathyroid venous sampling (SVS).
  • Data collected included patient demographics, medical/surgical history, serum calcium (Ca)-parathormone (PTH) levels, and imaging/surgery/pathology reports.
  • Analysis focused on SVS sensitivity and accuracy compared to medical history in persistent and primary cases.

Main Results:

  • Selective venous sampling demonstrated a sensitivity of 75% for localization.
  • Accurate localization was achieved in 85.7% of persistent primary hyperparathyroidism cases and 60% of primary cases based on medical history.
  • A single adenoma was found in 90.9% of cases, with double adenoma in 9.1%.

Conclusions:

  • Selective parathyroid venous sampling is a valuable tool for preoperative localization when conventional imaging is inconclusive.
  • It can improve localization accuracy, particularly in persistent primary hyperparathyroidism cases.
  • The study highlights the importance of considering advanced imaging techniques for complex parathyroid localization challenges.