Imaging for primary hyperparathyroidism - an evidence-based analysis

被引:118
作者
Mihai, Radu [3 ]
Simon, Dietmar [2 ]
Hellman, Per [1 ]
机构
[1] Univ Hosp, Dept Surg, SE-75185 Uppsala, Sweden
[2] Bethesda Hosp, Dept Surg, Duisburg, Germany
[3] John Radcliffe Hosp, Dept Surg, Oxford OX3 9DU, England
关键词
Primary hyperparathyroidism; Sestamibi scintigraphy; Ultrasound; Venous sampling; Positron emission tomography; Minimal invasive parathyroidectomy; Intraoperative PTH; Evidence-based analysis; MINIMALLY INVASIVE PARATHYROIDECTOMY; HIGH-RESOLUTION ULTRASONOGRAPHY; SURGEON-PERFORMED ULTRASOUND; POSITRON-EMISSION-TOMOGRAPHY; SPORADIC PRIMARY HYPERPARATHYROIDISM; 4-DIMENSIONAL COMPUTED-TOMOGRAPHY; TC-99M SESTAMIBI SCINTIGRAPHY; EVIDENCE BASED MEDICINE; FINE-NEEDLE-ASPIRATION; BROWN ADIPOSE-TISSUE;
D O I
10.1007/s00423-009-0534-4
中图分类号
R61 [外科手术学];
学科分类号
100210 [外科学];
摘要
Imaging in patients with primary hyperparathyroidism has been proven difficult. During the last decade, sestamibi scintigraphy and ultrasound (US) have been used with various success. The importance of these procedures has risen since minimal invasive parathyroid (MIP) surgery also has developed, and it is claimed that preoperative localization usually is needed before embarking on such a procedure. We have scanned the most recent literature in this matter in order to identify evidence, using commonly accepted grading, and also concluded a number of recommendations. We found evidence at level III leading to recommendations at grade B, that sestamibi scintigraphy is a recommended first test, but that US by an experienced investigator may be an alternative. MIP may be performed when both tests are concordant, and in case of only one test being positive, unilateral exploration and use of intraoperative PTH measurements are recommended. Bilateral neck exploration is used when both tests are negative. For reoperative procedures, repeat investigations are recommended, but also to use US-guided fine needle aspiration and PTH measurements as well as venous sampling. However, for reoperative procedures, the level of evidence is weaker-level IV, but recommendations still at grade B.
引用
收藏
页码:765 / 784
页数:20
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