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Parathyroid hormone venous sampling prior to reoperation forprimary hyperparathyroidism
Author(s) -
Estella E.,
Leong M. S. Z.,
Bennett I.,
Hartley L.,
Wetzig N.,
Archibald C.A.,
Harper J. S.,
Cuneo R. C.
Publication year - 2003
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1046/j.1445-2197.2003.02678.x
Subject(s) - medicine , primary hyperparathyroidism , parathyroid hormone , parathyroidectomy , scintigraphy , histopathology , sampling (signal processing) , radiology , surgery , pathology , filter (signal processing) , computer science , computer vision , calcium
Background: The surgical cure rate for primary hyperparathyroidismis greater than 95%. For those who have recurrent or persistentdisease, preoperative localization improves reoperation successrates. Selective parathyroid venous sampling (SPVS) for intact parathyroidhormone is particularly useful when non‐invasive localization techniquesare negative or inconclusive. Methods: We present all known cases ( n = 13)between 1994 and 2002 who had venous sampling for localization atour institution prior to reoperation for recurrent or persistentprimary hyperparathyroidism. Comparison was made with non‐invasivelocalization procedures. Results of invasive and non‐invasive localizationwere correlated with surgical findings. Results: Of the nine reoperated cases, eight had positive correlationsbetween SPVS and operative findings and histopathology. SPVS didnot reveal the parathyroid hormone source in one case with negativenon‐invasive localization procedures. Comparisons between SPVS,computerized tomography (CT), and parathyroid scintigraphy (MIBI)as expressed in terms of true positive (TP), false positive (FP)and false negative (FN) were: SPVS − TP88.8%, FP 0%, FN 11.1%; CT − TP22.2%, FP 22.2%, FN 55.5%; and MIBI − TP33.3%, FP 0%, FN 66.6%. At least sevenof the nine operated cases have been cured; another remained normocalcaemic 2 weeksafter subtotal parathyroidectomy. Conclusion: In our institution SPVS has proven to be a valuabletool in cases with recurrent or persistent primary hyperparathyroidismand negative non‐invasive localization procedures.