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De la Hoz Rodríguez Á, Muñoz De Nova JL, Muñoz Hernández P, Valdés de Anca Á, Serrano Pardo R, Tovar Pérez R, Martín-Pérez E. Oxyphil cells in primary hyperparathyroidism: a clinicopathological study. Hormones (Athens) 2021; 20:715-721. [PMID: 34228313 DOI: 10.1007/s42000-021-00305-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The role of oxyphil cells (OxC) in primary hyperparathyroidism (PHPT) still remains controversial. Historically, they were believed to be involuted cells. However, they could play an important role in hormone secretion. The clinical behavior of OxC-rich adenomas and preoperative PHPT localization tests have been widely studied. The aim of this study is to analyze the implications of OxC in PHTP. METHODS A retrospective cohort study of patients undergoing parathyroidectomy for PHPT was conducted. Additionally, we included normal glands removed in the context of PHPT or inadvertently during a thyroidectomy. All glands were reviewed independently by three researchers, performing a semi-quantitative analysis of the percentage of OxC. Groups with < 25% OxC and > 75% OxC were compared. RESULTS In the period 2010-2017, 238 patients and 261 removed glands were included (8.8% OxCA > 75%). There were no differences in symptomatology and levels of preoperative calcium, parathormone, or 25-OH vitamin. Patients with OxCA > 75% had worse preoperative glomerular filtration rate (81.2 vs. 69.7 mL/min/1.73 m2; p = 0.043). They also had a trend towards larger size and weight (17 vs. 20 mm, p = 0.135 and 562 vs. 875 mg, p = 0.495), while ultrasound was found to have better accuracy (48.3% vs. 73.7%; p = 0.035). There were no normal glands with a content of OxC > 75%. CONCLUSIONS Our study suggests that phosphocalcic metabolism is not influenced by the presence of a high content of OxC in the parathyroid glands. A high content of OxC seems to be exclusive to pathologic glands and could be related to the deterioration of renal function in patients with PHPT.
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Affiliation(s)
- Ángela De la Hoz Rodríguez
- General Surgery Department, Hospital Universitario de La Princesa, C/Diego de Leon 62, 4th Floor, 28006, Madrid, Spain
- Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - José Luis Muñoz De Nova
- General Surgery Department, Hospital Universitario de La Princesa, C/Diego de Leon 62, 4th Floor, 28006, Madrid, Spain.
- Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
- Universidad Autónoma de Madrid (UAM), Madrid, Spain.
| | | | - Álvaro Valdés de Anca
- General Surgery Department, Hospital Universitario de La Princesa, C/Diego de Leon 62, 4th Floor, 28006, Madrid, Spain
- Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | | | - Rodrigo Tovar Pérez
- General Surgery Department, Hospital Universitario de La Princesa, C/Diego de Leon 62, 4th Floor, 28006, Madrid, Spain
- Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Elena Martín-Pérez
- General Surgery Department, Hospital Universitario de La Princesa, C/Diego de Leon 62, 4th Floor, 28006, Madrid, Spain
- Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
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Update of the role of Nuclear Medicine techniques in the pre-surgical localization of primary hyperparathyroidism. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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García-Talavera San Miguel P, Gómez-Caminero López F, Villanueva Curto JG, Tamayo Alonso MP, Martín Gómez ME. Update of the role of Nuclear Medicine techniques in the pre-surgical localization of primary hyperparathyroidism. Rev Esp Med Nucl Imagen Mol 2019; 38:123-135. [PMID: 30738915 DOI: 10.1016/j.remn.2018.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 12/16/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
Primary hyperparathyroidism is one of the most frequent endocrine disorders. Its diagnosis is biochemical. Imaging techniques are not useful for the diagnosis of this pathology; they are just tools for pre-surgical localization. In this continuing education, we will analyze the different imaging modalities used in this indication, focusing on Nuclear Medicine. The most commonly used imaging technique in this context is the parathyroid scintigraphy, nowadays double phase protocol with 99mTc-MIBI and the double tracer with 99mTc-MIBI/99mTc-pertechnetate, associated in the first case to SPECT or SPECT/CT, in an early or late phase. The PET/CT with different tracers is showing good results, especially applied to cases of failure in the pre-surgical scintigraphic localization. We expose the results of the morphological imaging techniques as well as the usefulness of combining techniques.
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Affiliation(s)
| | - F Gómez-Caminero López
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - J G Villanueva Curto
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - M P Tamayo Alonso
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - M E Martín Gómez
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Salamanca, Salamanca, España
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Cordes M, Dworak O, Papadopoulos T, Coerper S, Kuwert T. MIBI scintigraphy of parathyroid adenomas: correlation with biochemical and histological markers. Endocr Res 2018; 43:141-148. [PMID: 29461127 DOI: 10.1080/07435800.2018.1437747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE In this study, we tested the hypothesis that MIBI-positive and MIBI-negative adenomas of parathyroid glands (APGs) have distinct biochemical and histological markers that could help differentiate MIBI-positive from MIBI-negative APGs. PATIENTS AND METHODS 40 patients with 41 APGs were included in the study. Patients were enrolled in the study after MIBI scintigraphy examinations had been carried out. Biochemical analyses included serum levels of calcium (Ca), intact parathyroid hormone (iPTH), and 25-hydroxyvitamin D3 (25-OH-D3). All patients had neck ultrasound and MIBI examinations. After surgical resection the APGs were examined histologically. RESULTS In each of 39 patients one APG could be confirmed by histology, and in one patient, two contralateral APGs were identified. MIBI studies were positive in 73 % and negative in 27 % of the APGs. False-positive cases were not observed. MIBI-negative APGs were only present in patients with iPTH values below 150 pg/ml. In 82 % of MIBI negative studies oxyphilic cells were absent, and this cell type was present in only 18 % of MIBI negative cases (p < 0.001). Regarding cysts within the APGs, no differences were demonstrated between MIBI positive or negative studies (p = 0.32). Fat cells were seen in none of the MIBI -negative studies and in only 3 % of MIBI positive studies (p = 0.08). CONCLUSIONS For APGs, MIBI positivity correlates with serum iPTH concentration. The absence of oxyphilic cells with large numbers of mitochondria in APGs contributes to MIBI negativity, probably because of the reduced binding sites for the radiotracer.
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Affiliation(s)
- Michael Cordes
- a Radiologisch-Nuklearmedizinisches Zentrum - RNZ , Nuremberg , Germany
| | - Otto Dworak
- b Pathologisches Institut , Klinikum Fuerth , Fuerth , Germany
| | | | - Stephan Coerper
- d Klinik fuer Allgemein- und Viszeralchirurgie , Krankenhaus Martha Maria , Nuremberg , Germany
| | - Torsten Kuwert
- e Nuklearmedizinische Klinik , Universitaetsklinikum Erlangen , Erlangen , Germany
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Abstract
Objective The aim of this study was to further elucidate the mechanisms of dual-phase technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) parathyroid imaging by exploring the association between early uptake results (EUR), delayed uptake results (DUR), and the retention index (RI) in dual-phase 99mTc-MIBI parathyroid imaging and P glycoprotein (P-gp), multidrug resistance-associated protein 1 (MRP1), and glutathione S-transferase-π (GST-π) expression in hyperparathyroidism (HPT). Patients and methods Preoperative dual-phase (early and delayed) 99mTc-MIBI imaging was performed on 74 patients undergoing parathyroidectomy for HPT. EUR, DUR, and RI were calculated. P-gp, MRP1, and GST-π expressions were assessed using immunohistochemistry in resected tissue from HPT and control patients. The association between P-gp, MRP1, and GST-π expressions and EUR, DUR, and RI in HPT was evaluated. Results The positive rate of dual-phase 99mT c-MIBI imaging was 91.89% (68/74) and the false-negative rate was 8.11% (6/74). P-gp and GST-π expressions were higher in tissues resected from control compared with HPT patients (47.37 and 81.5%, P<0.05); there was no difference in MRP1. EUR were associated with P-gp and GST-π expressions, and DUR were associated with MRP1 expression. There was a significant difference in MRP1 expression between RI greater than or equal to 0 and RI less than 0. There was no relationship between the sensitivity of dual-phase 99mTc-MIBI imaging and P-gp, MRP1, and GST-π expressions in resected parathyroid tissue. The six false-negative HPT cases consisted of three P-gp (−)/MRP1 (−) tissues, three P-gp (−)/GST-π (−) tissues, and four MRP1 (−)/GST-π (−) tissues. Conclusion As P-gp and GST-π expressions were higher in tissues resected from control compared with HPT patients, 99mTc-MIBI may wash out faster from normal parathyroid tissue surrounding the lesion compared with the lesion itself, facilitating detection.
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Desiato V, Melis M, Amato B, Bianco T, Rocca A, Amato M, Quarto G, Benassai G. Minimally invasive radioguided parathyroid surgery: A literature review. Int J Surg 2016; 28 Suppl 1:S84-93. [DOI: 10.1016/j.ijsu.2015.12.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 04/10/2015] [Accepted: 05/10/2015] [Indexed: 01/08/2023]
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Changing practices in the surgical management of hyperparathyroidism – A 10-year review. Surgeon 2012; 10:314-20. [DOI: 10.1016/j.surge.2011.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 10/25/2011] [Indexed: 11/20/2022]
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Stucken EZ, Kutler DI, Moquete R, Kazam E, Kuhel WI. Localization of Small Parathyroid Adenomas Using Modified 4-Dimensional Computed Tomography/Ultrasound. Otolaryngol Head Neck Surg 2011; 146:33-9. [DOI: 10.1177/0194599811427243] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. To investigate whether parathyroid gland weight has an impact on the accuracy of preoperative localization of parathyroid adenomas with modified 4 dimensional computed tomography/ultrasound. And to determine if the weight of parathyroid adenomas can be calculated accurately based on the dimensions of the gland on the CT images. Study Design. Case series with chart review. Setting. Tertiary care hospital. Subjects and Methods. One hundred forty-two patients who had a preoperative modified 4-dimensional computed tomography/ultrasound and underwent parathyroidectomy for hyperparathyroidism due to a parathyroid adenoma between 1998 and 2009. Charts were reviewed to identify (1) the sensitivity and specificity for localization of parathyroid adenomas according to gland weight and (2) correlation between preoperative estimate of parathyroid weight and the surgical weight of the parathyroid gland. Results. Modified 4-dimensional computed tomography/ultrasound displayed 92% sensitivity for localizing adenomas weighing <150 mg to the correct side of the neck (95% confidence interval [CI], 65%-99%), 100% sensitivity for glands weighing 150 to 500 mg (95%-100%), and 98% sensitivity for glands weighing >500 mg (92%-100%). For localization to the correct quadrant of the neck, sensitivity was 75% (95% CI, 47%-91%) for glands weighing <150 mg, 89% (79%-95%) for those weighing 150 to 500 mg, and 94% (85%-97%) for glands weighing >500 mg. A positive correlation was seen between the preoperative weight estimate based on imaging and the operative weight of the gland, with a Pearson correlation coefficient of 0.96. Conclusion. Modified 4-dimensional computed tomography/ultrasound can closely predict the weight of parathyroid glands preoperatively and has good sensitivity for localization of adenomas, even in glands weighing less than 150 mg.
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Affiliation(s)
- Emily Z. Stucken
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York, USA
| | - David I. Kutler
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York, USA
| | - Rachel Moquete
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York, USA
| | - Elias Kazam
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York, USA
- Manhattan Diagnostic Radiology, New York, New York, USA
| | - William I. Kuhel
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York, USA
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9
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Abstract
In recent years, parathyroid surgery has evolved from traditional bilateral neck exploration to minimal invasive parathyroidectomy. This trend became possible due to preoperative localization imaging that guides the surgeon in the search for a parathyroid adenoma. Intraoperative adjuncts are complementary to preoperative localization and assist in localizing parathyroid glands, confirming parathyroid tissue and establishing a cure. Institutions and surgeons utilize different intraoperative adjuncts in different protocols with varying results. The purpose of this article is to review the available intraoperative adjuncts to parathyroid surgery and critically evaluate their utility, accuracy and their added value to the surgeon.
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Affiliation(s)
- Haggi Mazeh
- a Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, H4/722 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA
| | - Herbert Chen
- a Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, H4/722 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA
- b
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10
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Sendt W, Spieker K, Michael G, Jandt K, Altendorf-Hofmann A. Radio-guided parathyroidectomy in patients with primary hyperparathyroidism and concomitant multinodular goiter. Surg Today 2010; 40:825-30. [DOI: 10.1007/s00595-009-4144-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Accepted: 07/21/2009] [Indexed: 11/24/2022]
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Goasguen N, Chirica M, Roger N, Munoz-Bongrand N, Zohar S, Noullet S, de Roquancourt A, Cattan P, Sarfati E. Primary hyperparathyroidism from parathyroid microadenoma: specific features and implications for a surgical strategy in the era of minimally invasive parathyroidectomy. J Am Coll Surg 2010; 210:456-62. [PMID: 20347738 DOI: 10.1016/j.jamcollsurg.2009.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 12/14/2009] [Accepted: 12/14/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this study was to identify the specific preoperative characteristics of patients with parathyroid microadenoma and to report their outcomes after surgical treatment. STUDY DESIGN Parathyroid microadenomas (weight < 100 mg) were identified in 62 (6%) of the 1,012 patients operated on for a parathyroid adenoma between 1995 and 2004. Presentation and outcomes after surgery were compared with those of 124 patients operated on consecutively for parathyroid adenoma (>100 mg) during the last year of the study. All patients underwent bilateral surgical exploration of the neck. Success was defined as resection of a pathologic gland combined with normocalcemia at 6 months after operation. Logistic regression was used to test the relationship between groups and potential predictive factors of microadenoma. RESULTS There were 57 women (92%) and the median age was 57 years (range 29 to 77 years). Median preoperative calcemia and parathyroid hormone (PTH) serum levels were 2.64 mmol/L (range 2.31 to 3 mmol/L) and 79 pg/mL (range 30 to 189 pg/mL), respectively. There was no difference in the clinical presentation between patients with microadenoma and adenoma. Preoperative calcium (p < 0.001) and PTH serum levels (p = 0.014) were significantly higher in patients with adenoma. Calcium and PTH serum levels lower than 2.6 mmol/L and 60 pg/mL, respectively, predicted the presence of microadenoma with respective specificities of 0.89 and 0.87. Success rates were similar in the microadenoma and adenoma groups (92% vs 98%; p = 0.11). CONCLUSIONS Mild preoperative elevations of calcium or PTH serum levels should warn about the risk of microadenoma. In this setting, intraoperative difficulties should be expected in identifying the pathologic gland, and bilateral neck exploration should be the preferred surgical approach.
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Affiliation(s)
- Nicolas Goasguen
- Department of Endocrine and Digestive Surgery, Hôpital Saint-Louis, Paris, France
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12
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Assessment of Utility of Staining in the Intraoperative Localization of Parathyroid Glands. POLISH JOURNAL OF SURGERY 2010. [DOI: 10.2478/v10035-010-0013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Mihai R, Simon D, Hellman P. Imaging for primary hyperparathyroidism—an evidence-based analysis. Langenbecks Arch Surg 2009; 394:765-84. [PMID: 19590890 DOI: 10.1007/s00423-009-0534-4] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Accepted: 06/18/2009] [Indexed: 10/20/2022]
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14
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Intraoperative adjuncts in surgery for primary hyperparathyroidism. Langenbecks Arch Surg 2009; 394:799-809. [PMID: 19590891 DOI: 10.1007/s00423-009-0532-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 06/18/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE This paper is a review of the evidence base to produce recommendations for the use of intraoperative parathyroid hormone (PTH), radioguided parathyroidectomy (RGP), methylene blue (MB), frozen section, and intraoperative neuromonitoring during surgery for primary hyperparathyroidism (PHPT). MATERIALS AND METHODS A Medline keyword search of English-language articles led to the production of a draft document, subsequently revised by committee, containing levels of evidence and the grading of recommendations as proposed by the Agency for Healthcare Research and Quality. RESULTS Literature review provides the basis for clear recommendations on the use of intraoperative PTH at surgery for PHPT. There is little evidence to support the use of RGP, MB, routine frozen section, and intraoperative neuromonitoring.
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Hagag P, Kummer E, Weiss M. Primary hyperparathyroidism: role of the preoperative oral calcium loading test in the differential diagnosis between adenoma and hyperplasia. Calcif Tissue Int 2008; 83:404-13. [PMID: 19020789 DOI: 10.1007/s00223-008-9191-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 10/28/2008] [Indexed: 11/26/2022]
Abstract
Whereas the sensitivity of the membrane calcium receptors is decreased in parathyroid adenoma, extracellular calcium may reduce parathyroid hormone (PTH) secretion through the protein kinase C pathway in parathyroid hyperplasia. The aim of this study was to determine the role of a preoperative oral calcium loading test in the differential diagnosis between adenoma and hyperplasia. Twenty-two subjects with adenoma (group A, age +/- standard error 56 +/-2 years, female/male 15/7), 10 individuals with hyperplasia (group H, age 54 +/-3, female/male 8/2), and 32 age and gender pair-matched controls (group C) underwent the test. Calcium and PTH were measured before and 60, 120, and 180 min after oral administration of 1 g of calcium (as gluconolactate). Product P was defined as minimal PTH concentration (pg/mL) x maximal calcium concentration (mg/dL) during the test. Ratio R was defined as relative PTH decline/relative calcium increase. The PTH decline during the test in group H was comparable to that of the controls. PTH decline <30%, Product P > 1,100, and Ratio R < 4 diagnosed adenoma with specificity of 100%, 90%, and 100%, respectively. PTH decline >60% diagnosed hyperplasia with specificity of 100%. The total accuracy of the test (65%) was comparable to that of technetium-99 m sestamibi scintigraphy (66%) and better than that of ultrasonography (58%). The test may discriminate patients with sporadic diffuse hyperplasia from individuals with solitary adenoma in cases of primary hyperparathyroidism with an indication for surgery.
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Affiliation(s)
- P Hagag
- Endocrine Institute, Assaf Harofeh Medical Center, Zerifin, 70300, Israel.
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Erbil Y, Kapran Y, Işsever H, Barbaros U, Adalet I, Dizdaroğlu F, Bozbora A, Ozarmağan S, Tezelman S. The positive effect of adenoma weight and oxyphil cell content on preoperative localization with 99mTc-sestamibi scanning for primary hyperparathyroidism. Am J Surg 2008; 195:34-9. [PMID: 18082541 DOI: 10.1016/j.amjsurg.2007.01.040] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Revised: 01/16/2007] [Accepted: 01/16/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although the sensitivity of sestamibi scanning (MIBI) is high in patients with solitary parathyroid adenomas, negative sestamibi scan results are inevitable. The exact mechanism of visualization of abnormal and hyperfunctioning parathyroid tissue is not yet clear. The aims of this clinical study were (1) to evaluate positive and negative sestamibi scan results with regard to adenoma weight and oxyphil cell content and (2) to compare the effects of adenoma weight and oxyphil cell content on the results of sestamibi scanning. PATIENTS The patients were divided in 2 groups according to their sestamibi scan results. Group 1 consisted of 27 patients with positive sestamibi scan results, and group 2 consisted of 20 patients with negative sestamibi scan results. Parathyroid adenoma weight and oxyphil cell content were determined in all patients. RESULTS The weight and oxyphil cell content of the parathyroid adenomas in the patients of group 1 were significantly higher than those in the patients of group 2 (P = .001). An adenoma weight >600 mg and an oxyphil cell content >20% increased the rate of obtaining a positive sestamibi scan result 10- and 4-fold, respectively. CONCLUSIONS Both adenoma weight and oxyphil cell content were found to significantly correlate with positive sestamibi scan results. In patients with high-weight adenomas, adenoma weight was the most significant factor in obtaining positive MIBI scan results, whereas in patients with low adenoma weights, high oxyphil cell content was the most significant factor in obtaining positive MIBI scan results.
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Affiliation(s)
- Yeşim Erbil
- Department of General Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
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17
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Gupta Y, Ahmed R, Happerfield L, Pinder SE, Balan KK, Wishart GC. P-glycoprotein expression is associated with sestamibi washout in primary hyperparathyroidism. Br J Surg 2007; 94:1491-5. [DOI: 10.1002/bjs.5882] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
Background
The detection of parathyroid adenomas by 99mTc-labelled hexakis 2-methoxyisobutyl isonitrile (sestamibi) scintigraphy is influenced by several factors, including tumour size and serum level of parathyroid hormone (PTH). This study examined the relationship between sestamibi accumulation and multidrug resistance (MDR)-related P-glycoprotein (P-gp) expression in a large series of surgically excised parathyroid tumours.
Methods
Seventy-eight patients underwent dual-phase sestamibi imaging before parathyroidectomy. Expression of P-gp within tumour cells was assessed by immunohistochemistry. Tumour size was measured and the ellipsoid volume calculated. Scan results were analysed in relation to preoperative serum levels of calcium and PTH, P-gp expression and tumour volume.
Results
Sixty-four of the 78 sestamibi scans were positive and 14 negative. Smaller adenomas (less than 0·5 cm3) were more likely to be sestamibi negative than larger lesions (P = 0·006). Ten of 14 adenomas with negative imaging showed strong P-gp membrane positivity and 45 of 64 lesions with a positive scan did not show P-gp membrane expression, indicating a significant association between high P-gp membrane immunoreactivity and negative sestamibi result (P = 0·006).
Conclusion
These data suggest an association between P-gp membrane expression and false-negative sestamibi scan result. Inhibition of the P-gp transmembrane pump using MDR modulators may therefore improve the sensitivity of sestamibi scintigraphy.
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Affiliation(s)
- Y Gupta
- Department of Endocrine Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - R Ahmed
- Department of Histopathology, Addenbrooke's Hospital, Cambridge, UK
| | - L Happerfield
- Department of Histopathology, Addenbrooke's Hospital, Cambridge, UK
| | - S E Pinder
- Department of Histopathology, Addenbrooke's Hospital, Cambridge, UK
| | - K K Balan
- Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - G C Wishart
- Department of Endocrine Surgery, Addenbrooke's Hospital, Cambridge, UK
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Takeuchi H, Greep NC, Hoon DSB, Giuliano AE, Hansen NM, Umetani N, Singer FR. Hypermethylation of adenosine triphosphate-binding cassette transporter genes in primary hyperparathyroidism and its effect on sestamibi imaging. J Clin Endocrinol Metab 2007; 92:1785-90. [PMID: 17299072 DOI: 10.1210/jc.2006-2010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Retention of technetium-(99m)-sestamibi ((99m)Tc-sestamibi) by parathyroid adenomas appears to be due to the loss of at least one membrane transporter, multidrug resistance 1 (MDR1), and possibly another, multidrug resistance-associated protein 1 (MRP1). OBJECTIVE The objective was to determine whether hypermethylation of either gene plays a role in their expression and (99m)Tc-sestamibi retention. DESIGN This was a retrospective study on a convenience sample of paraffin-embedded parathyroid glands. SETTING The study was performed at the John Wayne Cancer Institute at Saint John's Health Center (Santa Monica, CA). PATIENTS Forty-eight patients with primary hyperparathyroidism and five patients without parathyroid disease undergoing thyroid surgery provided 27 adenomatous, 10 hyperplastic, and 16 normal parathyroid glands. INTERVENTION We performed immunohistochemistry, real-time quantitative RT-PCR, and methylation-specific PCR for MDR1 and MRP1 on archival parathyroid tissue and correlated these results with the patient's (99m)Tc-sestamibi scan. MAIN OUTCOME MEASURE The main outcome measure was to determine whether hypermethylation of the genes for either transporter is associated with loss of their expression and with a positive (99m)Tc-sestamibi scan. RESULTS The MDR1 gene was methylated in none of 12 normal glands, 19 of 27 adenomas, and three of 10 hyperplastic glands. Methylation of the MRP1 gene was uncommon (five of 48 tested glands). Methylation of the gene affected the transcript level only for MDR1. Among all glands, hypermethylation for MDR1 was more likely in (99m)Tc-sestamibi-positive scans (P < 0.001). CONCLUSION In parathyroid tissue, hypermethylation of the MDR1 gene decreases its expression and is associated with increased detection of parathyroid adenomas by (99m)Tc-sestamibi parathyroid scans.
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Affiliation(s)
- Hiroya Takeuchi
- Department of Molecular Oncology, John Wayne Cancer Institute, 2200 Santa Monica Boulevard, Santa Monica, CA 90404, USA
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Lo CY, Lang BH, Chan WF, Kung AWC, Lam KSL. A prospective evaluation of preoperative localization by technetium-99m sestamibi scintigraphy and ultrasonography in primary hyperparathyroidism. Am J Surg 2007; 193:155-9. [PMID: 17236840 DOI: 10.1016/j.amjsurg.2006.04.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Revised: 04/10/2006] [Accepted: 04/10/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ultrasonography (USG) and technetium-99m sestamibi (MIBI) scintigraphy are commonly used imaging modalities in the era of minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism (pHPT). However, their relative importance and actual contribution to MIP have not been prospectively assessed. METHODS A total of 100 consecutive pHPT patients planning for MIP were recruited. Both USG and MIBI findings were correlated with intraoperative findings and postoperative outcome. Clinicopathologic factors were examined for potential association with a correct localizing result. RESULTS Thirty men and 70 women (age range 13 to 93 years [median 55.5]) were included in the study. The final pathology included 98 patients with solitary adenoma and 2 patients with multiglandular disease. The sensitivities, accuracies, and positive predicted values for USG and MIBI alone were 57% vs 89%, 56% vs 85%, and 97% vs 94%, respectively. Correctly localized adenomas were significantly heavier than incorrectly localized ones. CONCLUSIONS MIBI is preferred over USG in pHPT patients planning for MIP. Weight of adenoma appeared to be the only clinicopathologic factor determining localization accuracy.
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Affiliation(s)
- Chung-Yau Lo
- Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam Road, Hong Kong, China.
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Mihai R, Gleeson F, Buley ID, Roskell DE, Sadler GP. Negative Imaging Studies for Primary Hyperparathyroidism Are Unavoidable: Correlation of Sestamibi and High-Resolution Ultrasound Scanning with Histological Analysis in 150 Patients. World J Surg 2006; 30:697-704. [PMID: 16680585 DOI: 10.1007/s00268-005-0338-9] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preoperative localization studies with Tc99m-sestamibi have become an integral step in the preoperative assessment of patients with primary hyperparathyroidism (PHPT). This enables scan-directed minimally invasive parathyroidectomy (MIP) to be the preferred treatment for PHPT in many units. This study aimed to identify factors that lead to negative imaging studies in patients with PHPT. METHODS Over a 3-year period consecutive unselected patients with PHPT underwent Tc99m-sestamibi scanning and high-resolution ultrasound (US) scanning by the same radiologist. When localization studies were concordant, patients underwent MIP. Those patients with negative imaging studies underwent bilateral neck exploration. Histology slides were independently reviewed and the proportion of chief cells and oxyphil cells within each adenoma was estimated. RESULTS One hundred and fifty-eight patients underwent localization studies (38 men and 120 women, aged 61.8 +/- 15.2 years). Sestamibi scans were negative in 52 (32%) and positive in 106 (68%) patients. There was a higher incidence of hyperplasia in the group of patients with negative sestamibi scans (4 out of 52 vs. 4 out of 103, P < 0.05, chi2 test). In patients with negative sestamibi scans the majority of adenomas were formed predominantly from chief cells (26 out of 36) while the majority of patients with adenomas composed predominantly of oxyphil cells had positive scans (21 out of 23) (P < 0.05, chi2 test). The weight of parathyroid adenomas was higher when sestamibi scans were positive (median: 1,180 vs. 517 mg, P < 0.05, Student's t-test). CONCLUSION Successful preoperative localization of parathyroid adenomas using Tc99m-sestamibi scanning is influenced by the cytological predominance of individual tumors. Negative scans might therefore be unavoidable in a subgroup of patients.
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Affiliation(s)
- Radu Mihai
- Department of Endocrine Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 7LJ, UK
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