Selective Venous Blood Sampling for Hyperparathyroidism with unclear Localization of the Parathyroid Gland

Abstract

Purpose: Evaluation of the benefit of selective venous blood sampling (SVS) for the preoperative identification of parathyroid adenomas with unclear localization in non-invasive diagnostics.

Materials and Methods: In a retrospective study, all patients (n = 23) with primary (n = 21) or tertiary (n = 2) hyperparathyroidism were evaluated from 2005 to 2016 at the Hospital Nuremberg-North. These patients all received one (n = 20) or more (n = 3) SVS. 15 patients had one or more previous unsuccessful surgeries (group A), 8 patients received the SVS primarily before the first surgery (group B). Results of SVS were compared with the results of surgery, non-invasive diagnostic procedures and clinical follow up.

Results: In 24 out of 26 SVS a significant PTH peak was found. 19 patients underwent surgery after SVS. In 16 of these cases (84 %) the SVS peak was concordant with the intraoperative localization. Thus, SVS of all operated patients had a sensitivity of 94 %. Considering only patients with prior HPT surgery the sensitivity was 89 %. In none of the 26 examinations complications occurred.

Conclusion: Our results demonstrate that selective venous blood sampling SVS in cases with unclear imaging of parathyroid adenomas is an effective and low-risk invasive diagnostic method to localize parathyroid adenomas and helps to improve surgical therapy.

Key points:

• low risk invasive diagnostic procedure to localize parathyroid adenomas

• additional step if non-invasive diagnostics are negative or inconclusive

• high sensitivity in the detection of parathyroid adenomas

Citation Format:

• Hader C, Uder M, Loose RWR et al. Selective Venous Blood Sampling for Hyperparathyroidism with unclear Localization of the Parathyroid Gland. Fortschr Röntgenstr 2016; 188: 1144 – 1150

Zusammenfassung

Ziel: Bewertung des Nutzens des selektiven Venenblutsamplings (SVS) zur präoperativen Identifikation von Nebenschilddrüsenadenomen bei unklarer Lokalisation in der nichtinvasiven Diagnostik.

Material und Methoden: In einer retrospektiven Studie wurden alle Patienten (n = 23) mit primärem (n = 21) oder tertiärem (n = 2) Hyperparathyreoidismus (HPT) untersucht, die im Zeitraum von 2005 bis 2016 am Klinikum Nürnberg-Nord eine (n = 20) oder mehrere (n = 3) SVS erhalten haben. 15 Patienten waren bereits ein- oder mehrmals erfolglos operiert worden (Gruppe A), 8 erhielten die SVS primär vor der Erstoperation (Gruppe B). Die Resultate der SVS wurden anhand der Operationsergebnisse, der histologischen Befunde sowie des klinischen Verlaufs evaluiert.

Ergebnisse: 24 der 26 durchgeführten SVS zeigten einen signifikanten PTH-Peak. 19 Patienten wurden nach Durchführung der SVS operiert. Davon war die SVS in 16 Fällen (84 %) konkordant zur intraoperativen Lokalisation. Somit hatte die SVS für alle operierten Patienten eine Sensitivität von 94 %, bezüglich der Patienten mit HPT-Voroperation allein ergab sich eine Sensitivität von 89 %. Bei keiner der 26 Untersuchungen traten Komplikationen auf.

Schlussfolgerung: Unsere Ergebnisse zeigen, dass die SVS bei unklarer nichtinvasiver Bildgebung von Nebenschilddrüsenadenomen ein effektives und risikoarmes invasives diagnostisches Verfahren darstellt, um Nebenschilddrüsenadenome zu lokalisieren und so den Erfolg der chirurgischen Therapie des HPT zu verbessern.

Key words

parathyroid - angiography - hyperparathyreoidism - selective venous sampling

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