ECE2011 Poster Presentations Endocrine disruptors (11 abstracts)
Parathyroid adenoma screening efficacies of different imaging tools and factors affecting the success rates
E Çakal 1 , E Cakir 1 , A Dilli 2 , N Colak 1 , I Ozturk 1 , M Ozbek 1 , M Kilic 3 & T Dellibasi 1
1Department of Endocrinology and Metabolism, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey; 2Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey; 3Department of Surgery, Etlik Ihtisas Training and Research Hospital, Ankara, Turkey.
Introduction: To evaluate the efficacy of 3 different parathyroid adenoma screening tools (high resolution ultrasonography (USG), technetium Tc 99m-methoxyisobutylisonitrile (MIBI) parathyroid scintigraphy and magnetic resonance imaging (MR)) and to determine factors affecting the detection success rates.
Methods: Thirty-nine patients (29 female and 10 male) with primary hyperparathyroidism were included in the study. Patient’s mean age was 53.9±14.1. Patients were examined with USG, 99mTc-MIBI parathyroid scintigraphy and cervical MR imaging to detect hyperplastic parathyroid tissue and parathyroid adenoma and compare the 3 different imaging tools according to the detection success.
Results: Patient’s mean age was 53.2±13.7. Mean calcium (Ca), 24 h urine Ca, ALP and parathyroid hormone levels were 11.6±1.3 mg/dl, 624.8±305.7 mg/day, 197.7±84.7 U/l and 254.9±212.7 ng/ml respectively. Among the 39 patients; USG, parathyroid scintigraphy and cervical MR imaging correctly identified 35 adenomas (89.7%), 28 adenomas (71.8%) and 26 adenomas (66.7%) respectively. Positive predictive value for USG (34/35), scintigraphy (27/28) and cervical MR (26/26) imaging were 97.1, 96 and 100%. Parathyroid adenomas were detected with 92.3% (36/39) certainity when both USG and scintigraphy modalities were applied together. Minimally invasive parathyroidectomy under local anestasia with unilateral incision was successfully performed in 24 (% 61.5) of 39 patients.
Conclusions: Minimally invasive surgery for parathyroid adenomas is in development and has equal success with traditional surgery however there is need for accurate localization of adenomas, in this study scintigraphy and ultrasound combination was found to be efficient in localizing adenomas for successful surgery. MR imaging should be reserved for detecting ectopic parathyroid tissue.
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