1
|
|
2
|
|
3
|
Moosvi SR, Smith S, Hathorn J, Groot-Wassink T. Evaluation of the radiation dose exposure and associated cancer risks in patients having preoperative parathyroid localization. Ann R Coll Surg Engl 2017; 99:363-368. [PMID: 28462644 DOI: 10.1308/rcsann.2017.0014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The study aimed to evaluate the total effective and organ absorbed radiation doses associated with three- and four-phase parathyroid computed tomography (CT) and sestamibi scans used for the preoperative localisation of parathyroid adenomas in a cohort of patients with primary hyperparathyroidism at a single institution. We aimed to assess the risk of cancer incidence for the organs demonstrating the highest absorbed doses for the different imaging techniques, and more specifically determine the risk for our cohort of patients. METHODS Fifty patients with primary hyperparathyroidism had both multiphase CT and sestamibi scans. The Imaging Performance Assessment of CT Scanners (ImPACT) calculator was used to estimate the patient-effective and organ-absorbed radiations doses for all the CT examinations. For sestamibi scans, the US Nuclear Regulatory Commission NUREG/CR-6345 publication was used to estimate the dose for each patient. The attributable risks of cancer were calculated using the Health Protection Agency HPA-CRCE-028 publication. RESULTS The mean patient total effective doses were 15.9% ± 2.8 mSv, 20.2% ± 2.8 mSv and 5.6 ± 0.24 mSv for three-phase CT, four-phase CT and sestamibi examinations, respectively. In our cohort, the highest attributable lifetime risk was for lung cancer (0.03%) after multiphase CT. This compared with a tenfold lower risk for thyroid cancer (0.003%). After sestamibi, the highest risk was for colon cancer (0.06%). CONCLUSIONS Multiphase CT is associated with a higher radiation dose and thus a higher potential risk of cancer, but this risk is low in the older population that constituted the majority of our cohort.
Collapse
Affiliation(s)
- S R Moosvi
- Department of General Surgery, Ipswich Hospital NHS Trust , Ipswich, Suffolk , UK
| | - S Smith
- Department of Radiology, Ipswich Hospital NHS Trust , Ipswich, Suffolk , UK
| | - J Hathorn
- Department of Radiology, Ipswich Hospital NHS Trust , Ipswich, Suffolk , UK
| | - T Groot-Wassink
- Department of General Surgery, Ipswich Hospital NHS Trust , Ipswich, Suffolk , UK
| |
Collapse
|
4
|
Bahl M, Sepahdari AR, Sosa JA, Hoang JK. Parathyroid Adenomas and Hyperplasia on Four-dimensional CT Scans: Three Patterns of Enhancement Relative to the Thyroid Gland Justify a Three-Phase Protocol. Radiology 2015; 277:454-62. [PMID: 26024308 DOI: 10.1148/radiol.2015142393] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To describe the prevalence of three relative enhancement patterns of parathyroid lesions on four-dimensional (4D) computed tomographic (CT) scans. MATERIALS AND METHODS The institutional review board approved this HIPAA-compliant study and waived the need for informed consent. The authors retrospectively reviewed preoperative 4D CT scans obtained from November 2012 to June 2014 in 94 patients with pathologically proven parathyroid adenomas or hyperplasia. Lesions were classified into one of three relative enhancement patterns. All patterns required lesions to be lower in attenuation than the thyroid on non-contrast material-enhanced images, but patterns differed in the two contrast-enhanced phases. Type A lesions were higher in attenuation than the thyroid in the arterial phase, type B lesions were not higher in attenuation than the thyroid in the arterial phase but were lower in attenuation than the thyroid in the delayed phase, and type C lesions were neither higher in attenuation than the thyroid in the arterial phase nor lower in attenuation than the thyroid in the delayed phase. The prevalence of the relative enhancement patterns was compared. The t test was used to compare mean attenuation differences in Hounsfield units between the relative enhancement patterns. RESULTS Ninety-four patients had 110 parathyroid lesions, including 11 patients with multigland disease. The sensitivity for single-gland disease was 94% (78 of 83) and that for multigland disease was 59% (16 of 27). Type B enhancement was most common, with a prevalence of 57% (54 of 94), followed by type C (22% [21 of 94]) and type A (20% [19 of 94]). Five lesions were interpreted incorrectly as parathyroid adenoma (false-positive), and all lesions had the type C pattern. Relative to the thyroid, lesions categorized as type A by readers had mean attenuation difference (± standard deviation) of 39 HU ± 13 in the arterial phase, and type B lesions had a difference of -58 HU ± 26 in the delayed phase. These values differed from the mean attenuation difference of lesions not in these categories (P < .001). CONCLUSION Parathyroid adenomas and hyperplasia can be grouped into three relative enhancement patterns based on a protocol with a non-contrast-enhanced and two contrast-enhanced phases. The type B pattern is most common and could be diagnosed with two contrast-enhanced phases. However, almost one quarter of lesions have the type C pattern and thus could be missed without the non-contrast-enhanced phase.
Collapse
Affiliation(s)
- Manisha Bahl
- From the Department of Radiology, Division of Neuroradiology, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710
| | - Ali R Sepahdari
- From the Department of Radiology, Division of Neuroradiology, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710
| | - Julie A Sosa
- From the Department of Radiology, Division of Neuroradiology, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710
| | - Jenny K Hoang
- From the Department of Radiology, Division of Neuroradiology, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710
| |
Collapse
|
5
|
Cham S, Sepahdari AR, Hall KE, Yeh MW, Harari A. Dynamic Parathyroid Computed Tomography (4DCT) Facilitates Reoperative Parathyroidectomy and Enables Cure of Missed Hyperplasia. Ann Surg Oncol 2015; 22:3537-42. [PMID: 25691276 DOI: 10.1245/s10434-014-4331-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Four-dimensional computed tomography (4DCT) is an emerging imaging modality in the evaluation of primary hyperparathyroidism (PHPT). We assessed the role of 4DCT in patients presenting for reoperative parathyroidectomy. METHODS A prospective database of patients with persistent or recurrent PHPT undergoing reoperative parathyroidectomy during the years 2006-2014 was analyzed. Patients treated before versus after the advent of 4DCT were compared for operative eligibility, operative success, operative time, and concordance of imaging results with surgical findings. RESULTS Ninety patients were included in the study (61 before 4DCT, 29 after 4DCT). The post-4DCT group had a higher rate of surgical concordance with imaging results (63 vs. 90 %, p < 0.01) and shorter operative time (114 vs. 76 min, p < 0.05). The operative success rate was not different (87 vs. 86 %). A similar pattern was observed in the subset of sestamibi-negative patients, with post-4DCT patients having a higher rate of surgical concordance (12 vs. 83 %, p < 0.0001) and shorter operative time (181 vs. 89 min, p < 0.05). Among patients ultimately found to have parathyroid hyperplasia, 4DCT correctly identified multiple enlarged glands in 80 % (4 of 5) and correctly lateralized one or more glands in 100 % (5 of 5) of cases, facilitating successful subtotal parathyroidectomy in the reoperative setting. CONCLUSIONS 4DCT enables successful and efficient reoperative parathyroidectomy. These benefits extend to difficult cases, including sestamibi-negative patients and those with missed hyperplasia.
Collapse
Affiliation(s)
- Stephanie Cham
- Section of Endocrine Surgery, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Ali R Sepahdari
- Department of Radiology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Kimberly E Hall
- Section of Endocrine Surgery, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Michael W Yeh
- Section of Endocrine Surgery, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Avital Harari
- Section of Endocrine Surgery, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| |
Collapse
|
6
|
Casella C, Rossini P, Cappelli C, Nessi C, Nascimbeni R, Portolani N. Radioguided Parathyroidectomy with Portable Mini Gamma-Camera for the Treatment of Primary Hyperparathyroidism. Int J Endocrinol 2015; 2015:134731. [PMID: 26451143 PMCID: PMC4586957 DOI: 10.1155/2015/134731] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/03/2015] [Indexed: 11/17/2022] Open
Abstract
Background. A proper localisation of pathological parathyroid glands is essential for a minimally invasive approach in the surgical treatment of primary hyperparathyroidism (PHP). The recent introduction of portable mini gamma-cameras (pMGCs) enabled intraoperative scintigraphic scanning. The aim of our study is to evaluate the efficacy of this new method and compare it with the preoperative localisation surveys. Methods. 20 patients were studied; they were evaluated preoperatively by neck ultrasound and (99mm)Tc-sestaMIBI-scintigraphy and intraoperatively with the pMGC IP Guardian 2. The results obtained from the three evaluations were compared. Results. The pMGC presented a sensitivity of 95%, a specificity of 98.89%, and a diagnostic accuracy of 98.18%, which were higher than those of preoperative ultrasound (sensitivity 55%; specificity 95%; diagnostic accuracy 87%) and scintigraphy with (99mm)Tc-sestaMIBI (sensitivity 73.68%; specificity 96.05%; diagnostic accuracy 91.58%). Conclusions. The pMGC can be used effectively as an intraoperative method to find the correct location of the pathological parathyroid glands. The pMGC is more reliable than the currently used preoperative and intraoperative localisation techniques.
Collapse
Affiliation(s)
- Claudio Casella
- Department of Molecular and Translational Medicine, Spedali Civili, 3rd Division of General Surgery, University of Brescia, 25123 Brescia, Italy
- *Claudio Casella:
| | | | - Carlo Cappelli
- Department of Medical and Surgical Sciences, Spedali Civili, 2nd Division of Internal Medicine, University of Brescia, 25123 Brescia, Italy
| | - Chiara Nessi
- Department of Molecular and Translational Medicine, Spedali Civili, 3rd Division of General Surgery, University of Brescia, 25123 Brescia, Italy
| | - Riccardo Nascimbeni
- Department of Molecular and Translational Medicine, Spedali Civili, 3rd Division of General Surgery, University of Brescia, 25123 Brescia, Italy
| | - Nazario Portolani
- Department of Molecular and Translational Medicine, Spedali Civili, 3rd Division of General Surgery, University of Brescia, 25123 Brescia, Italy
| |
Collapse
|
7
|
Suh YJ, Choi JY, Kim SJ, Chun IK, Yun TJ, Lee KE, Kim JH, Cheon GJ, Youn YK. Comparison of 4D CT, ultrasonography, and 99mTc sestamibi SPECT/CT in localizing single-gland primary hyperparathyroidism. Otolaryngol Head Neck Surg 2014; 152:438-43. [PMID: 25518904 DOI: 10.1177/0194599814562195] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The present study was designed to evaluate 4D computerized tomography (CT) as a means of localizing abnormal parathyroid glands in primary hyperparathyroidism (HPT). STUDY DESIGN Case series with expertized image review. SETTING Tertiary care hospital. SUBJECTS AND METHODS A total of 38 patients were recruited for study, all of whom had undergone focused parathyroidectomy for single-lesion primary HPT between June 2011 and September 2013. In each patient, 3 imaging procedures were performed: cervical ultrasonography (US), 99mTc-sestamibi SPECT/CT (SeS), and 4D CT. Collective imaging data were blindly reviewed and compared. RESULTS 4D CT outperformed US and SeS in terms of sensitivity (P=.27), specificity (P=.01), positive predictive value (PPV) (P<.01), negative predictive value (NPV) (P=.19), and accuracy (P<.01). In 7.9% (3/38) of patients, 4D CT provided specific anatomic information that was unaffordable by US and SeS. Localization by 4D CT correlated with tissue parathyroid hormone level (P=.02), maximum diameter (P=.01), and volume (P<.01) of abnormal parathyroid glands. CONCLUSION 4D CT proved helpful in localizing target parathyroid glands of primary HPT that were missed by traditional imaging.
Collapse
Affiliation(s)
- Yong Joon Suh
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - June Young Choi
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Su-jin Kim
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - In Kook Chun
- Department of Nuclear Medicine, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Tae Jin Yun
- Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Gi Jeong Cheon
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea Department of Nuclear Medicine, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Yeo-Kyu Youn
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
8
|
Coorough NE, Schneider DF, Rosen MW, Sippel RS, Chen H, Schwarze ML, Mazeh H. A survey of preferences regarding surgical approach to thyroid surgery. World J Surg 2014; 38:696-703. [PMID: 24366272 DOI: 10.1007/s00268-013-2405-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Transaxillary thyroidectomy (TAT) has gained popularity in East Asian countries; however, to date there have been no attempts to evaluate the preferences regarding TAT in the US population. The aim of this study is to assess the preferences and considerations associated with TAT in an American cohort. METHODS Self-administered surveys were distributed to 966 adults at various locations in a single state. Questions assessed preferences for the surgical approach, acceptable risks and extra costs, and willingness to pursue TAT despite reduced cancer treatment efficacy. RESULTS The response rate was 84 %, with a mean age of 40 ± 17 years. The majority of respondents were female. Of the respondents, 82 % preferred TAT to a cervical thyroidectomy (CerT), all risks being equal; 51 % of the respondents were willing to accept a 4 % complication rate with TAT, and 16 % stated they would agree to pay up to an additional $US5,000 for the TAT approach. When presented with thyroid cancer, 20 % of all respondents still preferred TAT, even if it would not cure their disease. Patients preferring TAT over CerT were younger, female, more willing to accept complications and spend additional money, and, most significantly, preferred the TAT approach, even if it was less likely to cure their cancer. CONCLUSIONS Although this survey presents a hypothetical question for people who do not have thyroid disease, the majority of respondents preferred TAT over CerT. Furthermore, a substantial number were willing to accept higher complication rates and increased costs for TAT.
Collapse
|