Keywords
Secondary hyperparathyroidism
How to Cite
Abstract
Methods for preoperative localization of parathyroidin secondary hyperparathyroidism are controversial in the literature and have different and dissimilar sensitivity. With the objective to determine the correlation between preoperative ultrasound, scintigraphy MIBI and intraoperative findings in secondary hyperparathyroidism we review our 10 years statistic.Between2004-2014, 100 patients underwent parathyroidectomy due to secondary hyperparathyroidism. Data obtained from medical records included: preoperative serum parathormona, ultrasound, scintigraphy. Positive predictive value and negative predictive value were analyzed in correlation with intraoperative findings.The method of calculation of ROC curves and area under the curve and other screening values (confidence index, index of validity and likelihood ratio) were used. 68% were women; mean age was 52,7 years. Mean PTH value was 1486 pg/ml. The specificity and sensitivity of preoperative ultrasound were 94,44% and 30,14%, respectively. PPV was 93,62% and NPV was 33,33%. For scintigraphy, the sensitivity was 25,34%, specificity 98,15%, PPV was 97,37% and NPV was 32,72%. The ultrasound diagnosed 94 glands among a possibility of 400, the scintigraphy showed 76 and the surgery founded 292. Recurrence, 22%. Ultrasound and scintigraphy allow the localization of pathological parathyroid; however, in 10% of cases,glands could not be detected preoperatively, making surgeons experience fundamental in gland localizationReferences
Ferrer-Ramírez M, Amoros-Sebastia L, Cano Terol C, Caballero Calabuig E, Hernández Mijares A, López Martínez R. Valor diagnóstico de las técnicas de localización paratiroidea en la cirugía del hiperparatiroidismo primario. Acta Otorrinolaringol Esp. 2003;54(2):220-24
Arkles L, Jones T, Hicks R, De Luise M, Chou S. Impact of complementary parathyroide scintigraphy and ultrasonography on the surgical management of hyperparathyroidism. Surgery. 1996;120(5):845-51
Perinetti H. Hiperparatiroidismo primario, secundario y terciario: actualización. Instituto de Patología de la Tiroides. Departamento de Medicina Quirúrgica F.C.M UN Cuyo. Rev. Médica Universitaria. Diciembre 2005;1(1):20-47
Nicholson J, Veitch P, Feehally J. Parathyroidectomy in chronic renal failure: comparison of three operative strategies. Journal of the Royal Coll Surg Edinb 1996;41:382-7
Druke T, Zingraff J. The dilemma of parathyroidectomy in chronic renal failure. Curr Opin Nephrol Hypertens. 1994;3(4):386-95
Kinnaert P, Tielemans C, Dhaene M, Descorter G. Evaluation of surgical treatment of renal hyperparathyroidism by measuring intact parathormone blood levels on first postoperative day. World J Surg. 1998;22(1):695-99
Arici C. Chean W, Ituarte P, Morita E, Lynch T, Siperstein A, et al. Can localization studie be used to direct focused parathyroid operations? Surgery. 2001;129(6):720-9
Gamon R. Escrig J, Salvador J. Marcote E, Lara A, De Lera J. El rendimiento diagnóstico del Tc-99-sestamibi cambia según la localización y el tipo de hiperparatiroidismo. Análisis multivalente. Cir. Esp. 2002;71(3):133-6
Rodríguez-Gonzalez J, Ortiz S, Hernandez A, Claver M, Soria Cogollos T, Ramirez Romero A, et al. Utilidad y limitaciones del sestamibi99 TC como diagnóstico de localización en el hiperparatiroidismo. Cir. Esp. 1996;60(1):400-3
Isaac G. Perspectivas actuales en el manejo quirúrgico del hiperparatiroidismo primario. Rol delmonitoreo intraoperatorio de parathormona. Separata Montpellier. 2013;21(4):1-40
Berber E, Parikh N, Ballen N, Garner C, Siperstein A. Factors contributing to negative parathyroid localization: an analysis of 1000 patients. Surgery. 2008;144(1):74-79
Friedman K, Somervell H, Patel P. Effect of calcium channel blockers on the sensitivity of preoperative 99m Tc-Mibi spect for hyperparathyroidism. Surgery. 2004;136(6):1199-1204
Markarian M, Yelin G, Aparicio R, Marino J. Utilidad del centellograma TC 99-Sestamibi en la detección de adenomas e hiperplasias de glándulas paratiroides. Rev. Argent. Radiol. 2005;69(1):69-77
Coakley A, Kettle A, Wells C. Technetium-99-sestamibi- a new agent for parathyroid imaging. Nucl Med Commun. 1989;10(11):791-4
Casas A, Burke G. Sathyanarayana M, Jr, Wei J. Prospective comparison of technetium-99m-sestamibi-iodine-123 radionuclide scan versus high-resolution ultrasonography for the preoperative localization of abnormal glands in patients with previously unoperated primary hyperparathyroidism. Am J Sug. 1993;166(4):369-73
Dawson-Saunders B, Trapp GR. Bioestadística Médica. 3ª Edición. México DF: Manual Moderno; 2002:97-100
Aliabadi-Wahle S. Kelly TL, Rozenfeld Y, Carlisle JR, Naeole LK, Negreanu FA, Schuman E, Hammill CW, Am Surg. 2014 Nov;80(11):1146-51
Magnabosco FF, Tavares MR, Montenegro FL. Surgical treatment of secondary hyperparathyroidism: a systematic review of the literature. Arq Bras Endocrinol Metabol. 2014 Jul;58(5):562-71
Medina-Ruiz BA, Dami-Cañisa HR, Bogado-Yinde LA, Ojeda-Fiore H, Rodriguez I, Lezcano H. Anatomía Quirúrgica de las Glándulas Paratiroides. Rev Arg Anat Onl. 2011;2(4):118-125
Chen CL, Lin SH, Yu JC, Shih ML. Persistent renal hyperparathyroidism caused by intrathyriodal parathyroide glands. J Chin Med Assoc. 2014 Sep;77(9):492-5
Kuo LE, Wachtel H, Karakousis G, Fraker D, Kelz R. Parathyroidectomy in dialysis patients. J Surg Res. 2014 Aug;190(2):554-8
Richards M. Wormuth JB and Sirinek K. Parathyroidectomy in secondary hyperparathytoidism: Is there an optimal operative management? Surgery. 2003 Feb;138(2):174-80.
Ishani A, Liu J, Wetmore JB, Lowe KA, Do T, Bradbury BD, Block GA, Collins AJ. Clinical outcomes after parathyroidectomy in a nationwide cohort of patients on hemodialysis. Clin J Am Soc Nephrol. 2015 Jan;10(1)90-7