Utility of intraoperative bilateral internal jugular venous sampling with rapid parathyroid hormone testing in guiding patients with a negative sestamibi scan for minimally invasive parathyroidectomy--a randomized controlled trial.
OBJECTIVE
The purpose of this study was to determine the utility of bilateral internal jugular venous sampling with rapid parathyroid hormone assay (BIJV-IOPTH) in comparison to endocrine surgeon-performed ultrasonography of the neck as an alternative localizing modality in guiding patients with primary hyperparathyroidism (pHPT) and negative sestamibi scans for minimally invasive parathyroidectomy (MIP).


METHODS
Seventy eight consenting patients with a negative subtraction sestamibi scan planned for parathyroidectomy underwent additional ultrasound parathyroid imaging and were randomized to undergo surgery without vs. with additional BIJV-IOPTH; n = 39 in each group. The patients with a positive alternative imaging test were qualified for video-assisted MIP, whereas the others underwent open neck explorations. The primary outcome measure was the number of patients with true-positive results of alternative imaging tests.


RESULTS
Of the 78 patients, 50 (64%) had a single adenoma, eight (10.3%) had double adenomas, and 20 (25.7%) demonstrated four-gland hyperplasia. Ultrasonography alone vs. combined with BIJV-IOPTH was true positive in detecting a solitary parathyroid adenoma in 8/24 (33.3%) vs. 17/26 (65.4%) patients, respectively (p = 0.023). Curative video-assisted MIP was successfully performed in all the patients with true-positive results. The remaining individuals were cured by more extensive open neck explorations (unilateral-4/39 vs. 4/39, respectively; p = 1.0 or bilateral-27/39 vs. 18/39, respectively; p = 0.039).


CONCLUSIONS
Most patients with pHPT and a negative subtraction sestamibi scan (64%) have a single adenoma. BIJV-IOPTH as an addition to a surgeon-performed ultrasound of the neck allows for more accurate guiding for MIP in patients with a solitary parathyroid adenoma and negative subtraction sestamibi scans.
Barczynski
Marcin
M
Department of Endocrine Surgery, Jagiellonian University College of Medicine, 37 Pradnicka Street, 31-202, Krakow, Poland. marbar@mp.pl
Konturek
Aleksander
A
Hubalewska-Dydejczyk
Alicja
A
Cichon
Stanislaw
S
Nowak
Wojciech
W
D000236:Adenoma / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery; D000328:Adult; D001800:Blood Specimen Collection; D005260:Female; D006801:Humans; D006965:Hyperplasia; D007601:Jugular Veins; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D016343:Monitoring, Intraoperative; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery; D016105:Parathyroidectomy; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D014463:Ultrasonography
D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi