Selective venous sampling in primary hyperparathyroidism: Is it worth doing?

Authors: SELDA GÜCEK HACİYANLI, NİHAN ACAR, ÖMÜR BALLI, NEZAHAT ERDOĞAN, MEHMET HACİYANLI

Abstract: Background/aim: Accurate preoperative localization of the culprit gland is the key point for the surgical treatment of primary hyperparathyroidism. Conventional imaging techniques (ultrasound and Tc99m sestamibi scintigraphy) are usually adequate for preoperative localization. However, in some patient groups, additional imaging modalities may be required since noninvasive techniques may fail. In this study, we aimed to evaluate the diagnostic value of selective parathyroid venous sampling in patients with unclear noninvasive localization tests. Materials and methods: Among 513 cases who underwent parathyroidectomy due to primary hyperparathyroidism, twelve cases (2.3%) were undergone selective parathyroid venous sampling and were included in the study. Age, sex, presenting symptom, presence of a genetic disease, medical and surgical history, serum calcium (Ca)-parathormone (PTH) levels (preoperative, intraoperative, and postoperative), imaging reports (US, SM, and SVS), surgery reports, pathology reports, and complications were retrospectively reviewed. Results: Seven cases (58.3%) had persistent primary hyperparathyroidism and one patient (8.3%) had past surgical history of total thyroidectomy. The remaining four patients (33.3%) had no previous neck surgery. The sensitivity of selective venous sampling was 75%. According to the medical history, accurate localization was achieved in 85.7% of persistent cases and 60% of primary cases. Eight cases (66.6%) underwent unilateral neck exploration and four cases (33.3%) underwent four gland exploration. A single adenoma was detected in ten cases (90.9%) while one patient (9.1%) had double adenoma. Conclusion: Selective venous sampling is a prominent technique with high accuracy in persistent cases when the conventional imaging methods are negative or equivocal. Although the cost and invasiveness are the most common confusing facts about selective venous sampling, its benefits such as improving the surgical success and saving the patients from repeated operations may surpass them.

Keywords: Persistent, primary hyperparathyroidism, venous sampling, 4D-CT, 4D-MRI, parathyroidectomy

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