Selective parathyroid venous sampling in patients with complicated hyperparathyroidism.
OBJECTIVE
The role of preoperative localisation of abnormal parathyroid glands remains controversial but is particularly relevant to the management of patients with recurrent or persistent hyperparathyroidism and familial syndromes. We report our experience of the use of selective parathyroid venous sampling (PVS) in the localisation of parathyroid disease in such patients.


METHODS
We report a retrospective 10-year experience (n = 27) of the use of PVS in complicated primary hyperparathyroidism and contrast the use of PVS with neck ultrasound, magnetic resonance imaging (MRI), computed tomography (CT) and sestamibi imaging modalities.


RESULTS
In 14 out of 25 patients who underwent surgery PVS results were completely concordant with surgical and histological findings and 88% of patients achieved post-operative cure. Out of 13 patients referred after previous failed surgery, 12 underwent further surgery which was curative in 9. In total PVS yielded useful positive (n = 13) and/or negative information (n = 6) in 19 out of 25 patients undergoing surgery. Using histology as the gold standard, 59% of PVS studies were entirely consistent with histology, as compared with 39% of ultrasound scans, 36% of sestamibi scans and 17% of MRI/CT scans.


CONCLUSIONS
PVS is a valuable adjunct to MRI/CT and sestamibi scanning in selected patients with complicated hyperparathyroidism when performed in an experienced unit.
Ogilvie
C M
CM
Department of Endocrinology, St Bartholomew's Hospital, London, UK.
Brown
P L
PL
Matson
M
M
Dacie
J
J
Reznek
R H
RH
Britton
K
K
Carpenter
R
R
Berney
D
D
Drake
W M
WM
Jenkins
P J
PJ
Chew
S L
SL
Monson
J P
JP
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology*; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011300:Preoperative Care; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012086:Reoperation; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D014057:Tomography, X-Ray Computed; D014683:Vena Cava, Superior
D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi