gms | German Medical Science

130. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

30.04. - 03.05.2013, München

The value of preoperative localization of parathyroid adenomas for intended minimally invasive parathyroidectomy in patients with primary hyperparathyroidism

Meeting Abstract

  • Martin Gasser - Universitätsklinikum Würzburg, Chirurgische Klinik I, Würzburg
  • Andrea Busch - Universitätsklinikum Würzburg, Chirurgische Klinik I, Würzburg
  • Reinhard Lorenz - Universitätsklinikum Würzburg, Klinik für Nuklearmedizin, Würzburg
  • Andreas Buck - Universitätsklinikum Würzburg, Klinik für Nuklearmedizin, Würzburg
  • Ana Maria Waaga-Gasser - Universitätsklinikum Würzburg, Chirurgische Klinik I, Würzburg
  • Christoph Reiners - Universitätsklinikum Würzburg, Klinik für Nuklearmedizin, Würzburg
  • Christoph-Thomas Germer - Universitätsklinikum Würzburg, Chirurgische Klinik I, Würzburg

Deutsche Gesellschaft für Chirurgie. 130. Kongress der Deutschen Gesellschaft für Chirurgie. München, 30.04.-03.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. Doc13dgch531

doi: 10.3205/13dgch531, urn:nbn:de:0183-13dgch5310

Veröffentlicht: 26. April 2013

© 2013 Gasser et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Bilateral neck exploration of the parathyroid glands is the mainstay of surgical treatment for primary hyperparathyroidism. Minimally invasive parathyroidectomy (OMIP/MIP) with direct approach towards the abnormal parathyroid gland has been increasingly used with overall advantages due to the minimal invasive procedure. As this technique requires preoperative localization of the pathologic parathyroid gland, predictive reliability was critically evaluated with the outcome analysis of each patient.

Material and methods: A total of 271 patients with primary hyperparathyroidism underwent a parathyroidectomy in our department. Almost all parathyroidectomies (96%) were primary interventions (10 re-explorations). Patients with a solitary parathyroid adenoma (n=242/271) were included. Those with double adenomas (n=13) or multigland hyperplasia (n=14) on primary diagnosis were excluded from the OMIP procedure. Ultrasound examination and Sesta-MIBI scanning was performed in 225 patients (93%). Magnetic resonance imaging or invasive venous parathormone (PTH)-determination for discrimination (via femoral vein catheter) was performed on rare indication.

Results: Overall 77% of the pathologic parathyroid glands were identified on their correct side via Sesta-MIBI scan. In comparison ultrasound scan demonstrated a lesser accuracy (69%) for sensitivity. The positive predictive value was 98% for scintigraphic scanning and 96% for the ultrasound technique. Interestingly, combining both techniques resulted in a sensitivity of 86%. Twenty (9%) of the 54 (23%) negative findings observed by Sesta-MIBI scan were positively detected when using additionally ultrasound imaging.

Conclusion: Combined Sesta-MIBI scanning and ultrasound diagnostic is a reliable tool to identify single parathyroid adenomas in patients with primary hyperparathyroidism and allows minimally invasive approaches in most cases when combined with intraoperative determination of PTH. Additional techniques like Methionin PET-CT, MRI or invasive PTH determination remain to be important (only in 10-15% of the affected patients), particularly for those patients, who are intended for an OMIP/MIP procedure.