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Pace-Asciak P, Tufano RP. Future Directions in the Treatment of Thyroid and Parathyroid Disease. Otolaryngol Clin North Am 2024; 57:155-170. [PMID: 37634983 DOI: 10.1016/j.otc.2023.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
The surgical management of thyroid and parathyroid disease has evolved considerably since the era of Theodor Kocher. We review the current trends in thyroid and parathyroid surgery concerning robotic surgery for remote access, the use of parathyroid autofluorescence detection technology to aid in the prevention of hypocalcemia as well as the use of thermal ablation to target thyroid nodules in a minimally invasive way. We also discuss how artificial intelligence is being used to improve the workflow and diagnostics preoperatively as well as for intraoperative decision-making. We also discuss potential areas where future research may enhance outcomes.
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Affiliation(s)
- Pia Pace-Asciak
- Department of Otolaryngology-Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Ralph P Tufano
- Sarasota Memorial Health Care System Multidisciplinary Thyroid and Parathyroid Center, Sarasota, FL, USA
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2
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León Utrero S, Garrido-Pareja F, López-Ibarra P, Quesada-Charneco M, López-Mezquita E, Ávila-Rubio V, Martín-Rodríguez JL. Effectiveness and safety of the radiofrequency ablation of single hyperfunctioning parathyroid lesions suggestive of adenomas in primary hyperparathyroidism. J Endocrinol Invest 2023; 46:2269-2273. [PMID: 37032399 DOI: 10.1007/s40618-023-02078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/22/2023] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Radiofrequency ablation (RFA) has emerged as a minimally invasive approach to single parathyroid adenoma in primary hyperparathyroidism; however, there is limited evidence on its effectiveness. OBJECTIVE To evaluate the effectiveness and safety of RFA to treat hyper-functioning parathyroid lesions suggestive of adenomas. MATERIAL AND METHODS A prospective study was conducted in consecutive patients with primary hyperparathyroidism treated with RFA for single parathyroid lesions in our reference center between November 2017 and June 2021. Pre-treatment (baseline) and follow-up analytical data were gathered on total protein-adjusted calcium, parathyroid hormone [PTH], phosphorus, and 24-h urine calcium. Effectiveness was defined as complete response (normal calcium and PTH), partial response (reduced but not normalized PTH with normal serum calcium), or disease persistence (elevated calcium and PTH). SPSS 15.0 was used for statistical analysis. RESULTS Four of thirty-three enrolled patients were lost to the follow-up. The final sample comprised 29 patients (22 females) with mean age of 60.93 ± 13.28 years followed up for a mean of 16.29 ± 7.23 months. Complete response was observed in 48.27%, partial response in 37.93%, and hyperparathyroidism persistence in 13.79%. Serum calcium and PTH levels were significantly lower at 1 and 2 years of post-treatment than at baseline. Adverse effects were mild, with two cases of dysphonia (self-limited in one patient) and no cases of hypocalcaemia or hypoparathyroidism. CONCLUSION RFA may be a safe and effective technique to treat hyper-functioning parathyroid lesions in selected patients.
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Affiliation(s)
- S León Utrero
- Department of Endocrinology and Nutrition, University Hospital Clínico San Cecilio, Av. de La Ilustración, s/n, 18016, Granada, Spain
| | - F Garrido-Pareja
- Department of Radiology, University Hospital Clínico San Cecilio, Av. de La Ilustración, s/n, 18016, Granada, Spain
| | - P López-Ibarra
- Department of Endocrinology and Nutrition, University Hospital Clínico San Cecilio, Av. de La Ilustración, s/n, 18016, Granada, Spain
| | - M Quesada-Charneco
- Department of Endocrinology and Nutrition, University Hospital Clínico San Cecilio, Av. de La Ilustración, s/n, 18016, Granada, Spain
| | - E López-Mezquita
- Department of Endocrinology and Nutrition, University Hospital Clínico San Cecilio, Av. de La Ilustración, s/n, 18016, Granada, Spain
| | - V Ávila-Rubio
- Department of Endocrinology and Nutrition, University Hospital Clínico San Cecilio, Av. de La Ilustración, s/n, 18016, Granada, Spain
| | - J L Martín-Rodríguez
- Department of Radiology, University Hospital Clínico San Cecilio, Av. de La Ilustración, s/n, 18016, Granada, Spain
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Chai HH, Dai ZJ, Xu B, Hu QH, He HF, Xin Y, Yue WW, Peng CZ. Clinical and Economic Evaluation of Ultrasound-Guided Radiofrequency Ablation vs. Parathyroidectomy for Patients with Primary Hyperparathyroidism: A Cohort Study. Acad Radiol 2023; 30:2647-2656. [PMID: 36966072 DOI: 10.1016/j.acra.2023.02.020] [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: 09/25/2022] [Revised: 02/03/2023] [Accepted: 02/19/2023] [Indexed: 03/27/2023]
Abstract
RATIONALE AND OBJECTIVES To compare the clinical and economic effects of ultrasound (US)-guided radiofrequency ablation (RFA) with parathyroidectomy (PTX) for primary hyperparathyroidism (PHPT). MATERIALS AND METHODS From April 2014 to April 2021, 123 PHPT patients who received US-guided RFA or PTX were studied. Propensity score (PS) matching was used to balance the baseline data of the two groups. The rates of cure, recurrent and persistent PHPT, and complications were compared. A Chinese healthcare system perspective cost minimization analysis was conducted. RESULTS After PS matching, 37 patient pairs (1:1) were created for the two groups. Follow-up was 27.2 ± 10.6 months and 28.8 ± 16.1 months for the RFA and PTX groups, respectively. At the last follow-up, there was no evidence of differences regarding clinical cure rate between the two groups (RFA vs. PTX, 91.9% vs. 94.6%, p = 1.000). Recurrent PHPT did not develop in any patient. One patient in each group had persistent PHPT. The incidence of complications and side effects, except postoperative pain (RFA vs. PTX, 16.2% vs. 40.5%, p = 0.020), were no significant difference between the two groups (all, p > 0.05). The incremental cost was -$284.00; thus, RFA was more cost-effective. For patients with employee medical insurance or resident medical insurance, the incremental costs (RFA vs. PTX) were -$391.94 and -$49.43, respectively. CONCLUSION There were no significant differences in efficacy and safety between RFA and PTX. As the incremental cost for RFA compared with PTX was negative, RFA may be used as a more cost-effective nonsurgical treatment alternative for PHPT.
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Affiliation(s)
- Hui-Hui Chai
- Department of Medical Ultrasound and Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhan-Jing Dai
- Center for Health Care Policy Research, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Bai Xu
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Qiao-Hong Hu
- Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Hong-Feng He
- Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Ying Xin
- Department of Head and Neck Surgery, Center of Otolaryngology, Head and Neck Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Wen-Wen Yue
- Department of Medical Ultrasound and Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Cheng-Zhong Peng
- Department of Medical Ultrasound and Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China.
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Combination Therapy of Ethanol Ablation and Radiofrequency Ablation to Treat Parathyroid Adenoma in a Case with Primary Hyperparathyroidism. IRANIAN JOURNAL OF RADIOLOGY 2022. [DOI: 10.5812/iranjradiol-120869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction: Ethanol ablation (EA) and radiofrequency ablation (RFA) are minimal invasive therapeutic modalities to treat primary hyperparathyroidism (PHPT). Case Presentation: A 77-year-old man presented a 3.5-cm parathyroid adenoma with mixed cystic and solid components. He was ineligible for parathyroidectomy because of his age and the surgical history of the coronary artery bypass graft. First, EA was performed to remove cystic component. After that, the volume of parathyroid adenoma was decreased (volume reduction rate: 94%); however, the level of serum parathyroid hormone (PTH) was persistently high (88 pg/mL). Subsequent RFA was performed to remove the remaining parathyroid adenoma. Further, it was completely disappeared on the following ultrasound examination, and PTH was normalized. The results during a 2-year follow-up confirmed clinical success, and no relevant complication was reported. Conclusion: The combination therapy of EA and subsequent RFA is safe and effective as an alternative therapeutic method to treat PHPT in patients ineligible for parathyroidectomy.
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Liu F, Liu Y, Peng C, Yu M, Wu S, Qian L, Han Z, Yu J, Chai H, Liang P. Ultrasound-guided microwave and radiofrequency ablation for primary hyperparathyroidism: a prospective, multicenter study. Eur Radiol 2022; 32:7743-7754. [PMID: 35593958 DOI: 10.1007/s00330-022-08851-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/21/2022] [Accepted: 04/28/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To prospectively investigate the efficacy and safety of ultrasound (US)-guided microwave ablation (MWA) and radiofrequency ablation (RFA) for primary hyperparathyroidism (PHPT). METHODS We performed a prospective multicenter study of MWA and RFA for PHPT between August 2017 and October 2020 at five centers. Laboratory testing was performed pre- and post-ablation and followed for at least 6 months. The primary outcome was the cure rate. Secondary outcomes were complications and dynamic changes in serum levels of PTH, calcium, phosphorus, and ALP after ablation. RESULTS A total of 132 participants (mean age, 57.33 ± 13.90 years), with 141 parathyroid nodules (median maximal diameter, 1.55 cm) undergoing either MWA or RFA, were enrolled in the study. The technique success rate was 99.29% (140/141). The follow-up period was 6-36 months (median, 12 months). The cure rate was 80.30% (106/132). Pre-ablation PTH level was the independent factor associated with cure rate (Odds ratio (OR), 0.22; 95% CI, 0.07-0.69; p = 0.0090). There was no difference in cure rate between the MWA group and the RFA group (80.22% vs. 80.49%, p = 0.971). The only main complication was hoarseness (5.30%). CONCLUSIONS US-guided MWA and RFA for PHPT is an effective and safe procedure in the treatment of PHPT. Pre-ablation PTH level is the key factor affecting the cure rate after MWA and RFA. KEY POINTS • To our knowledge, this is the first prospective multicenter clinical trial with ultrasound-guided MWA and RFA for primary hyperparathyroidism. • There was no difference in cure rate between the MWA and RFA groups for primary hyperparathyroidism. The overall cure rate was 80.30%. • Pre-ablation PTH level was the independent factor associated with cure rate (odds ratio (OR), 0.22; 95% CI, 0.07-0.69; p = 0.0090).
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Affiliation(s)
- Fangyi Liu
- Department of Interventional Ultrasound, The Fifth Medical Center, Chinese PLA General Hospital, NO.28 Fuxing Road, Beijing, 100853, China
| | - Yang Liu
- Department of Interventional Ultrasound, The Fifth Medical Center, Chinese PLA General Hospital, NO.28 Fuxing Road, Beijing, 100853, China
| | - Chengzhong Peng
- Department of Ultrasound, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Mingan Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan East Street, Chao-yang district, Beijing, 100029, China
| | - Songsong Wu
- Shengli Clinical Medical College of Fujian Medical University, Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Linxue Qian
- Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, The Fifth Medical Center, Chinese PLA General Hospital, NO.28 Fuxing Road, Beijing, 100853, China
| | - Jie Yu
- Department of Interventional Ultrasound, The Fifth Medical Center, Chinese PLA General Hospital, NO.28 Fuxing Road, Beijing, 100853, China
| | - Huihui Chai
- Graduate Department, Bengbu Medical College, Bengbu, 233000, Anhui, China
| | - Ping Liang
- Department of Interventional Ultrasound, The Fifth Medical Center, Chinese PLA General Hospital, NO.28 Fuxing Road, Beijing, 100853, China.
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Han Z, Li T, Wang S, Gao L, Hu Y, Zhao Y, Yan J. Ultrasound-Guided Radiofrequency Ablation for Primary Hyperparathyroidism Induced by Multiple Endocrine Neoplasia 1—A Case Report. Diagnostics (Basel) 2022; 12:diagnostics12102553. [PMID: 36292242 PMCID: PMC9600646 DOI: 10.3390/diagnostics12102553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 11/23/2022] Open
Abstract
Multiple endocrine neoplasia type 1 (MEN1) is a syndrome characterized by the occurrence of two or more endocrine gland tumors. Here, we show a case of a 52-year-old man diagnosed with MEN1 through gastrinoma, parathyroid adenoma and gene detection. The MEN1 patient’s case was complicated with relapsed primary hyperparathyroidism (PHPT), and they received ultrasound-guided radiofrequency ablation (RFA). The patient had a remarkable recovery after RFA treatment for the relapsed PHPT. It might be an alternative treatment for MEN1 patients with poor conditions such as high surgical risk, unwillingness to choose parathyroid surgery or those unable to tolerate surgery. Individualized therapy significantly benefits the prognosis of MEN1 patients.
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Affiliation(s)
- Zhenping Han
- Center for Clinical Pharmacy, Department of Pharmacy, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou 310014, China
- Department of Pharmacology, College of Pharmaceutical Sciences, Zhejiang University of Technology, Hangzhou 310014, China
| | - Tingting Li
- Center for Clinical Pharmacy, Department of Pharmacy, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou 310014, China
| | - Siyi Wang
- Center for Clinical Pharmacy, Department of Pharmacy, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou 310014, China
- Department of Pharmacology, College of Pharmaceutical Sciences, Zhejiang University of Technology, Hangzhou 310014, China
| | - Li Gao
- Center for Clinical Pharmacy, Department of Pharmacy, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou 310014, China
| | - Ying Hu
- Center for Clinical Pharmacy, Department of Pharmacy, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou 310014, China
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou 310014, China
| | - Yu Zhao
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou 310014, China
- Department of Endocrinology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou 310014, China
- Correspondence: (Y.Z.); (J.Y.); Tel.: +86-0571-85893117 (J.Y.)
| | - Jieping Yan
- Center for Clinical Pharmacy, Department of Pharmacy, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou 310014, China
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou 310014, China
- Correspondence: (Y.Z.); (J.Y.); Tel.: +86-0571-85893117 (J.Y.)
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Chen CC, Chen HL, Chiang PL, Luo SD, Chang YH, Chen WC, Wang CK, Lin AN, Chen YS, Chi SY, Lin WC. Efficacy and safety of radiofrequency ablation for primary and secondary hyperparathyroidism with or without previous parathyroidectomy: a retrospective study. Int J Hyperthermia 2022; 39:907-917. [PMID: 35848429 DOI: 10.1080/02656736.2022.2097324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION This study aimed to investigate and compare the therapeutic efficacy and safety of ultrasound-guided radiofrequency ablation (RFA), between primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism (SHPT) patients, with or without previous parathyroidectomy (PTX). SUBJECTS AND METHODS A total of 21 patients (7 PHPT, 14 SHPT) underwent RFA for hyperparathyroidism (HPT) at Kaohsiung Chang Gung Memorial Hospital, Taiwan. Five of the 14 SHPT patients had previously received PTX. The laboratory data, volume change of each parathyroid nodule, symptomatic scores, and complications were analyzed and compared between all groups at 1 and 7 days, and at 1, 3, 6, and 12 months after RFA. RESULTS After RFA, the volume reduction ratio (VRR) for all patients at the last follow-up was 93.76%, and clinical symptoms significantly improved. At 12 months, all PHPT patients achieved successful treatment of intact PTH (iPTH). In SHPT patients, the mean iPTH value significantly decreased 1-day post-RFA, subsequently exhibiting a transient rebound which proceeded to decrease, with 57.1% reaching successful treatment standards. SHPT patients with PTX showed a lower complication score, shorter ablation time, higher iPTH baseline and outcomes, and lower VRR, compared to patients without PTX. The serum calcium level significantly decreased to normal range in 85.7% of all patients at 12 months. Severe hypocalcemia occurred in 23.8% at 1 week, and all were corrected with calcium supplements. CONCLUSIONS RFA demonstrates a therapeutic efficacy similar to PTX. It can thus be considered an effective alternative treatment for PHPT, SHPT, or post-PTX patients who are unsuitable for another PTX.
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Affiliation(s)
- Chi-Cheng Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Ling Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Hsiang Chang
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chih Chen
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Kang Wang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - An-Ni Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yueh-Sheng Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shun-Yu Chi
- Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Baldwin CK, Natter MB, Patel KN, Hodak SP. Minimally Invasive Techniques for the Management of Thyroid Nodules. Endocrinol Metab Clin North Am 2022; 51:323-349. [PMID: 35662444 DOI: 10.1016/j.ecl.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Image-guided interventional techniques have emerged as promising treatments for thyroid disease. Percutaneous ethanol ablation, radiofrequency ablation, laser ablation, high intensity focused ultrasound, and microwave ablation have shown efficacy in treating benign thyroid disease. There is increasing evidence that these techniques may effectively treat papillary thyroid microcarcinomas, recurrent and metastatic disease, follicular neoplasms, and parathyroid lesions. They are performed in an outpatient setting, well-tolerated, with negligible risk for thyroid hormone supplementation, making them a popular alternative to surgical resection. In this comprehensive review, we discuss the devices, techniques, advantages, and disadvantages of each intervention, and summarize the published outcomes.
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Affiliation(s)
- Chelsey K Baldwin
- Department of Medicine, Diabetes and Endocrinology Section, New York University School of Medicine, 222 East, 41st Street, Floor 23, NY 10016, USA.
| | - Michael B Natter
- Department of Medicine, Diabetes and Endocrinology Section, New York University School of Medicine, 222 East, 41st Street, Floor 23, NY 10016, USA
| | - Kepal N Patel
- Otolaryngology and Biochemistry, Division of Endocrine Surgery, Department of Surgery, Division of Endocrine Surgery, New York University School of Medicine, 530 1st Avenue, Floor 12, NY 10016, USA
| | - Steven P Hodak
- Department of Medicine, Diabetes and Endocrinology Section, New York University School of Medicine, 222 East, 41st Street, Floor 23, NY 10016, USA
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Ebrahiminik H, Chegeni H, Mosadegh Khah A, Salouti R, Ghomashchi G, Deldar Pasikhani M, Heydari I, Shamsi K, Beiranvand B, Azimi Aval MR, Mohammadi A, Mirza-Aghazadeh-Attari M, Fadaee N. Radiofrequency ablation of parathyroid adenomas causing primary hyperparathyroidism: A report of 27 patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:540-546. [PMID: 35278235 DOI: 10.1002/jcu.23181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/12/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To study treatment outcome of parathyroid adenomas using ultrasound-guided radiofrequency ablation. METHODS Twenty-seven patients with a single adenoma of the parathyroid gland were included in the study. Using color Doppler ultrasonography, the lesion and its characteristics were determined, and dextrose was injected to dissect the gland from the surrounding structures. The ablation process was done with 6-12 watts of power. RESULTS No complications were seen in any of the subjects. A significant reduction was seen in serum parathyroid hormone (PTH) and calcium levels after treatment. PTH levels showed a median decrease of 13.8%, and a median decrease of 8.2% was seen in serum calcium levels (p < 0.001). Phosphorus levels did not change significantly after treatment. In 1-month follow-up of patients, the lesion size had decreased considerably. In long-term follow-up, 11 of 20 patients having subsequent imaging had indistinguishable lesions. CONCLUSION Our results showed that RFA of parathyroid adenomas caused a significant reduction in biomedical indicators of disease and resulted in a significant reduction or disappearance of the lesion in the majority of the patients while having no considerable complications.
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Affiliation(s)
- Hojat Ebrahiminik
- Department of Interventional Radiology and Radiation Sciences Research Center, Aja University of Medical Sciences, Tehran, Iran
| | | | - Ali Mosadegh Khah
- Department of Endocrinology, Aja University of Medical Sciences, Tehran, Iran
| | - Rambod Salouti
- Interventional Radiology Department, Tirad Imaging Institute, Tehrn, Iran
| | - Ghazal Ghomashchi
- Interventional Radiology Department, Tirad Imaging Institute, Tehrn, Iran
| | - Maryam Deldar Pasikhani
- Department of Obstetrics and Gynecology, School of Medicine, Vali Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Iraj Heydari
- Endocrinology Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Khosro Shamsi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Afshin Mohammadi
- Department of Radiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Narges Fadaee
- Department of Family Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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10
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Cansu GB. An effective and safe alternative treatment method in parathyroid adenomas: Radiofrequency ablation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:547-548. [PMID: 35521923 DOI: 10.1002/jcu.23180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Güven Barış Cansu
- Department of Endocrinology, Kutahya Health Science University, School of Medicine, Kutahya, Turkey
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11
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Peng CZ, Chai HH, Zhang ZX, Hu QH, Zeng Z, Cui AL, Pang HS, Ruan LT. Radiofrequency ablation for primary hyperparathyroidism and risk factors for postablative eucalcemic parathyroid hormone elevation. Int J Hyperthermia 2022; 39:490-496. [PMID: 35285391 DOI: 10.1080/02656736.2022.2047231] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Cheng-Zhong Peng
- Department of Ultrasound, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Tongji University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Hui-Hui Chai
- Graduate Department, Bengbu Medical College, Bengbu, China
| | - Zheng-Xian Zhang
- Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Qiao-Hong Hu
- Department of Ultrasound, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Zeng Zeng
- Department of Ultrasound, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Ai-Lin Cui
- Department of Ultrasound, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Hai-Su Pang
- Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Li-Tao Ruan
- Department of Ultrasound, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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Wei Y, Zhao ZL, Cao XJ, Peng LL, Li Y, Wu J, Yu MA. Microwave ablation versus parathyroidectomy for the treatment of primary hyperparathyroidism: a cohort study. Eur Radiol 2022; 32:5821-5830. [PMID: 35381852 PMCID: PMC9381471 DOI: 10.1007/s00330-022-08759-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 03/06/2022] [Accepted: 03/21/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To compare the clinical outcomes between microwave ablation (MWA) and parathyroidectomy (PTX) for the treatment of primary hyperparathyroidism (pHPT). MATERIALS AND METHODS This retrospective study enrolled 212 patients with pHPT treated by either MWA (MWA group) or PTX (PTX group) from January 2015 to October 2020. The baseline data were balanced through propensity score matching. Clinical cure was evaluated by the Kaplan-Meier method and compared between the MWA and PTX groups. The risk factors related to persistent or recurrent pHPT were screening out using a Cox proportional hazards regression model. RESULTS After propensity score matching, a total of 174 patients were enrolled in the present study, with 87 patients in each group. During the follow-up period (median, 28.5 months), there were no differences between the two groups regarding the clinical cure (hazard ratio, 1.71; 95% confidence interval: 0.81-3.62; p = .155), persistent pHPT rate (13.8% vs. 10.3%, p = .643), recurrent pHPT rate (6.9% vs. 3.4%, p = .496), or major complications (6.9% vs. 3.4%, p = .496). MWA resulted in a shorter procedure time (30 min vs. 60 min), smaller incision length (0.1 cm vs. 7 cm) and slightly higher costs (25745 CNY vs. 24111 CNY) (all p < .001). High levels of preoperative intact parathyroid hormone (p = .01) and multiple pHPT nodules (p < .001) were independent risk factors for recurrent and persistent pHPT in the two groups. CONCLUSION MWA and PTX have comparable clinical outcomes for pHPT. MWA has a shorter procedure time and smaller incision length. KEY POINTS • There were no differences in terms of clinical cure, persistent pHPT, recurrent pHPT, or major complications between MWA and PTX in the treatment of pHPT. • MWA is minimally invasive and results in a shorter procedure time. • Multiple nodules and high levels of iPTH were the independent risk factors for recurrent and persistent pHPT.
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Affiliation(s)
- Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan East Street, Chao-yang district, Beijing, 100029 China
| | - Zhen-long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan East Street, Chao-yang district, Beijing, 100029 China
| | - Xiao-jing Cao
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan East Street, Chao-yang district, Beijing, 100029 China
| | - Li-li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan East Street, Chao-yang district, Beijing, 100029 China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan East Street, Chao-yang district, Beijing, 100029 China
| | - Jie Wu
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan East Street, Chao-yang district, Beijing, 100029 China
| | - Ming-an Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan East Street, Chao-yang district, Beijing, 100029 China
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Wei Y, Peng CZ, Wang SR, He JF, Peng LL, Zhao ZL, Cao XJ, Li Y, Yu MA. Effectiveness and Safety of Thermal Ablation in the Treatment of Primary Hyperparathyroidism: A Multicenter Study. J Clin Endocrinol Metab 2021; 106:2707-2717. [PMID: 33846740 PMCID: PMC8372654 DOI: 10.1210/clinem/dgab240] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Indexed: 12/23/2022]
Abstract
CONTEXT Ultrasound (US)-guided thermal ablation has generated recent interest as minimally invasive treatments of primary hyperparathyroidism (pHPT). But definitive evidence for the efficacy of thermal ablation in treating pHPT is not well characterized. OBJECTIVE This work aims to evaluate the effectiveness and safety of thermal ablation for pHPT. METHODS From January 2015 to March 2020, data pertaining to patients who received thermal ablation for pHPT at 4 centers were retrospectively analyzed. The median follow-up duration was 18.1 months (interquartile range, 6.5-42.2 months). A cure referred to the reestablishment of normal values of serum calcium and intact parathyroid hormone throughout the entire follow-up period, at least more than 6 months. The technical success, effectiveness, and safety of treatment were analyzed. RESULTS A total of 119 patients (mean age, 57.2 ± 16.3 years; 81 female) with 134 parathyroid nodules were enrolled. The mean maximum diameter of the parathyroid glands was 1.6 ± 0.9 cm. Ninety-six patients underwent microwave ablation (MWA), and 23 patients underwent radiofrequency ablation (RFA). The technical success rate was 98.3% and the cure rate was 89.9%. Significant differences were found in the maximum diameter between the cured patients and the patients who did not undergo ablation of the target lesions. Except for cases with pHPT nodules less than 0.6 cm in diameter, the cure rate was 95%. There were no difference in cure rates at 6 months between the MWA and RFA groups (MWA vs RFA, 90.6% vs 87.0%; χ 2 = 0.275, P = .699). The volume reduction rate of the ablation zone was 94.6% at 12 months. The complication rate was 6.7% (8/119). With the exception of one patient with persistent voice impairment, other symptoms spontaneously resolved within 6 months. CONCLUSION Thermal ablation is effective and safe for pHPT.
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Affiliation(s)
- Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Chao-yang district, Beijing 100029, China
| | - Cheng-Zhong Peng
- Department of Ultrasound, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou 310014, China
| | - Shu-Rong Wang
- Department of Medical Ultrasound, Yantai Affiliated Hospital, Binzhou Medical University, Baotou 014000, China
| | - Jun-Feng He
- Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Yantai 264100, China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Chao-yang district, Beijing 100029, China
| | - Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Chao-yang district, Beijing 100029, China
| | - Xiao-Jing Cao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Chao-yang district, Beijing 100029, China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Chao-yang district, Beijing 100029, China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Chao-yang district, Beijing 100029, China
- Correspondence: Ming-an Yu, MD, Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan E St, Chao-yang district, Beijing 100029, China.
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Ultrasound-Guided Moving Shot Radiofrequency Ablation of Benign Soft Tissue Neoplasm. ACTA ACUST UNITED AC 2021; 57:medicina57080830. [PMID: 34441036 PMCID: PMC8402204 DOI: 10.3390/medicina57080830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 12/16/2022]
Abstract
Background and Objective: To evaluate the effectiveness of radiofrequency ablation (RFA) using the moving-shot technique for benign soft tissue neoplasm. Materials and Methods: This retrospective study reviewed eight patients with benign soft tissue neoplasm presenting with cosmetic concerns and/or symptomatic issues who refused surgery. Six patients had vascular malformation, including four with venous malformation and two with congenital hemangioma. The other two patients had neurofibroma. All patients underwent RFA using the moving-shot technique. Imaging and clinical follow-up were performed in all patients. Follow-up image modalities included ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging. The volume reduction ratio (VRR), cosmetic scale (CS), and complications were evaluated. Results: Among the seven patients having received single-stage RFA, there were significant volume reductions between baseline (33.3 ± 21.2 cm3), midterm follow-up (5.1 ± 3.8 cm3, p = 0.020), and final follow-up (3.6 ± 1.4 cm3, p = 0.022) volumes. The VRR was 84.5 ± 9.2% at final follow-up. There were also significant improvements in the CS (from 3.71 to 1.57, p = 0.017). The remaining patient, in the process of a scheduled two-stage RFA, had a 33.8% VRR after the first RFA. The overall VRR among the eight patients was 77.5%. No complications or re-growth of the targeted lesions were noted during the follow-up period. Of the eight patients, two received RFA under local anesthesia, while the other six patients were under general anesthesia. Conclusions: RFA using the moving-shot technique is an effective, safe, and minimally invasive treatment for benign soft tissue neoplasms, achieving mass volume reduction within 6 months and significant esthetic improvement, either with local anesthesia or with general anesthesia under certain conditions.
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Wei Y, Peng CZ, Wang SR, He JF, Peng LL, Zhao ZL, Cao XJ, Li Y, Chai HH, Yu MA. Microwave ablation versus radiofrequency ablation for primary hyperparathyroidism: a multicenter retrospective study. Int J Hyperthermia 2021; 38:1023-1030. [PMID: 34219596 DOI: 10.1080/02656736.2021.1945689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To compare the clinical outcomes of microwave ablation (MWA) and radiofrequency ablation (RFA) in the treatment of primary hyperparathyroidism (pHPT). METHOD This retrospective study included 104 pHPT patients treated by MWA or RFA between January 2015 and March 2020 in four centers. The clinical outcomes including effectiveness and complications were compared between the two groups. Ablation cure was defined as the reestablishment of normal values of serum calcium and intact parathyroid hormone (iPTH) at least more than 6 months. Clinical cure was defined as the reestablishment of normal values of serum calcium and iPTH throughout the entire follow-up period. RESULTS A total of 77 patients underwent MWA (mean age, 55.5 ± 16.4 years) and 27 underwent RFA (mean age, 58.9 ± 15.6 years). During the follow-up (median, 18.7 months in the MWA group; 12 months in the RFA group), no difference was observed between ablation cure rates (88.3% vs. 88.9%, p = 1.000), clinical cure rates (87.0% vs. 82.3%, p = .880), recurrent pHPT (5.2% vs. 3.7%, p = .447), persistent pHPT (11.7% vs. 11.1%, p = 1.000) and complication rate (9.1% vs. 3.7%, p = .677). A maximum diameter less than 0.7 cm was an independent prognostic factor of uncured pHPT in ablation (hazard ratio, 0.1; 95% confidence interval: 0.02, 0.54; p = .007). Major complication - voice change encountered in five patients (6.5%) in the MWA group and in one patient (3.7%) in the RFA group. CONCLUSION Both RFA and MWA are safe and effective techniques for patients with pHPT, with comparable clinical outcomes.
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Affiliation(s)
- Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Cheng-Zhong Peng
- Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Shu-Rong Wang
- Department of Medical Ultrasound, Yantai Affiliated Hospital, Binzhou Medical University, Yantai, China
| | - Jun-Feng He
- Department of Ultrasound, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Xiao-Jing Cao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Hui-Hui Chai
- Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
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Ying W, Zhen-Long Z, Xiao-Jing C, Li-Li P, Yan L, Ming-An Y. A study on the causes of operative failures after microwave ablation for primary hyperparathyroidism. Eur Radiol 2021; 31:6522-6530. [PMID: 33651201 PMCID: PMC8379100 DOI: 10.1007/s00330-021-07761-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/19/2021] [Accepted: 02/05/2021] [Indexed: 12/17/2022]
Abstract
Objective To summarize the occurrence of operative failures after microwave ablation (MWA) in patients with primary hyperparathyroidism (pHPT), analyze the possible reasons, and explore strategies for preventing and managing these situations. Methods This retrospective study reviewed 91 pHPT patients who underwent MWA from April 2015 to November 2019. A cure was defined as the reestablishment of normal calcium homeostasis lasting a minimum of 6 months. An operative failure was defined as a failure to normalize serum intact parathyroid hormone (iPTH) and/or calcium levels at 6 months or longer. Patients who encountered operative failures were compared with patients who were successfully cured. Results Eighty-eight pHPT patients, consisting of 29 men and 59 women, were finally enrolled. The median follow-up duration was 15.9 months (IQR, 6.1–31.5 months). Seventy-eight patients (78/88, 88.6%) were cured. Ten (10/88, 11.4%) patients experienced operative failure, including 9 persistent pHPT (10.2%) and 1 (1.1%) recurrent pHPT. Small parathyroid nodules (maximum diameter < 0.6 cm) and incomplete ablation were the two key factors leading to operative failure. Of the 9 patients with a maximum nodule diameter less than 0.6 cm, 77.8% (7/9) of them encountered operative failure. Conclusion Operative failure occurred in 11.4% of the pHPT patients who underwent MWA. The possibility of operative failure was increased when the maximum diameter of parathyroid nodule was less than 0.6 cm. Complete ablation could help avoid operative failure. Key Points • Failed to ablate the target lesion and incomplete ablation were the key factors attributed to operative failures. • When the maximum diameter of the parathyroid nodules is less than 0.6 cm, the possibility of operative failure was higher.
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Affiliation(s)
- Wei Ying
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan street, Chao-yang District, Beijing, 100029, China
| | - Zhao Zhen-Long
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan street, Chao-yang District, Beijing, 100029, China
| | - Cao Xiao-Jing
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan street, Chao-yang District, Beijing, 100029, China
| | - Peng Li-Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan street, Chao-yang District, Beijing, 100029, China
| | - Li Yan
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan street, Chao-yang District, Beijing, 100029, China
| | - Yu Ming-An
- Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan street, Chao-yang District, Beijing, 100029, China.
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Hussain I, Ahmad S, Aljammal J. Radiofrequency Ablation of Parathyroid Adenoma: A Novel Treatment Option for Primary Hyperparathyroidism. AACE Clin Case Rep 2021; 7:195-199. [PMID: 34095487 PMCID: PMC8165122 DOI: 10.1016/j.aace.2021.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective To present radiofrequency ablation (RFA) of parathyroid adenomas as a safe and effective management strategy for primary hyperparathyroidism in patients who are not eligible for surgery or those who do not want surgery. Methods The diagnosis of primary hyperparathyroidism was confirmed by laboratory investigations. A bone density scan showed osteoporosis, which was an indication for the surgical treatment of primary hyperparathyroidism. Ultrasonography of the neck was done to localize the parathyroid adenoma, after which RFA was performed to shrink the adenoma. Laboratory investigations were performed 10 days, 6 months, and 12 months after the procedure. A literature review was also conducted, and other reports of primary hyperparathyroidism cases treated with RFA were identified. Results Biochemical cure of primary hyperparathyroidism was achieved by normalization of calcium levels, resolution of symptoms, elimination of complications, and decrease in the volume of the parathyroid adenoma. Conclusion RFA of parathyroid adenomas is a viable alternative to parathyroidectomy in patients who do not meet the criteria for surgery or do not wish to undergo surgery.
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Affiliation(s)
- Iram Hussain
- Division of Endocrinology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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Ni W, Yuan Y, Chu X, Chen G, Han X, Li J, Wu X, Wang J, Liu C, Xu S. Bone Turnover Markers in Response to Ultrasound-Guided Microwave Ablation for Primary Hyperparathyroidism. Front Endocrinol (Lausanne) 2021; 12:782050. [PMID: 34925241 PMCID: PMC8672162 DOI: 10.3389/fendo.2021.782050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/15/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the efficacy and safety of ultrasound-guided microwave ablation (MWA) in the treatment of primary hyperparathyroidism (PHPT), and to investigate whether MWA can improve the bone turnover and renal function. METHODS A total of 20 consecutive PHPT patients with 21 parathyroid lesions treated with MWA in our center from May 2019 to March 2021 were recruited in this study. Serum parathyroid hormone (PTH), calcium and phosphorus levels before MWA and at 20 minutes, 4 hours, 1 day, 3 months, 6 months and 12 months after MWA were measured. Bone turnover biomarkers, renal function and lesion volume with volume reduction rate (VRR) before MWA and at the last follow-up were compared. Any complication related with MWA was evaluated. The technical and clinical success rates of MWA in the treatment of PHPT were calculated. Clinical success was defined as normal serum PTH and calcium without PHPT-associated manifestations at more than 6 months after ablation. Technical success was defined as complete ablation indicated by immediate postoperative contrast-enhanced ultrasound. RESULTS The serum PTH, calcium and phosphorus levels at their respective follow-up time points dropped significantly after MWA (P <0.05). The volume of parathyroid lesions at the final examination was significantly reduced, compared with pre-ablation volume (P <0.001), with a median VRR reaching 89%. The technical and clinical success rates were 100% and 63.6%, respectively. Substantial changes of bone turnover biomarkers were observed before and after MWA (P <0.05), but the differences in renal function were not statistically significant. No major complications were reported in all cases. Pre-MWA serum PTH, lesion volume, maximum diameter of lesion and ablation time were significantly different between patients with successful and failed MWA. CONCLUSIONS PHPT can be effectively and safely treated by ultrasound-guided MWA, as proven by drop in serum PTH and reduction in the volume of parathyroid adenomas. Besides, MWA can impede bone remodeling to suppress hyperparathyroidism in the condition of PHPT.
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Affiliation(s)
- Wenjing Ni
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yue Yuan
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaoqiu Chu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Guofang Chen
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Key Laboratory of TCM Syndrome & Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Xue Han
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jie Li
- Department of Ultrasound, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xinping Wu
- Department of Ultrasound, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianhua Wang
- Department of General Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chao Liu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Key Laboratory of TCM Syndrome & Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- *Correspondence: Chao Liu, ; Shuhang Xu,
| | - Shuhang Xu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- *Correspondence: Chao Liu, ; Shuhang Xu,
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Khandelwal AH, Batra S, Jajodia S, Gupta S, Khandelwal R, Kapoor AK, Mishra SK, Baijal SS. Radiofrequency Ablation of Parathyroid Adenomas: Safety and Efficacy in a Study of 10 Patients. Indian J Endocrinol Metab 2020; 24:543-550. [PMID: 33643872 PMCID: PMC7906106 DOI: 10.4103/ijem.ijem_671_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/18/2020] [Accepted: 12/16/2020] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To evaluate safety and effectiveness of ultrasound-guided percutaneous radiofrequency ablation of parathyroid adenoma in surgically unfit patients with hypercalcemia because of hyperparathyroidism. MATERIALS AND METHODS A retrospective review of hospital records from Jan 2012 to Dec 2018 revealed 10 patients, who had undergone ablation for solitary parathyroid adenoma. All 10 patients suffered from hyperparathyroidism because of parathyroid adenoma, resulting in hypercalcemia. These patients were surgically unfit because of comorbidities. Pre-ablation serum calcium and serum parathormone levels were measured and compared with the levels after the ablation. RESULTS Mean serum calcium level decreased significantly from 2.81 ± 0.17 mmol/L pre-ablation to 2.42 ± 0.17 mmol/L 72 h after ablation and parathyroid hormone levels became normal in all patients within 7 days. Seven patients remained normo-calcaemic at 6 months follow-up with no signs and symptoms of hyperparathyroidism. One patient with pancreatitis died after 15 days because of pre-existing multi-organ failure. Two patients were lost to follow-up before 6 months. CONCLUSION Radiofrequency ablation of parathyroid adenoma is a safe and effective alternate treatment method for symptomatic hypercalcemia in surgically unfit patients suffering from primary hyperparathyroidism because of parathyroid adenoma.
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Affiliation(s)
| | - Smarth Batra
- Department of Interventional Radiology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Surabhi Jajodia
- Department of Interventional Radiology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Saurabh Gupta
- Department of Interventional Radiology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Rohit Khandelwal
- Department of Interventional Radiology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Abhay Kumar Kapoor
- Department of Interventional Radiology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Sunil Kumar Mishra
- Department of Endocrinology and Metabolism, Medanta-The Medicity, Gurugram, Haryana, India
| | - S. S. Baijal
- Department of Interventional Radiology, Medanta-The Medicity, Gurugram, Haryana, India
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Dahiya N, Patel MD, Young SW. Neck Procedures: Thyroid and Parathyroid. Radiol Clin North Am 2020; 58:1085-1098. [PMID: 33040850 DOI: 10.1016/j.rcl.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Fine-needle aspiration (FNA) and core biopsy of masses in the neck predominantly include samples from thyroid nodules, parathyroids and lymph nodes. The diagnostic rate of a thyroid nodule FNA improves up to 6 passes and then does not significantly change. Thyroid FNA can be performed on patients who are anticoagulated. Appropriate transducer selection is essential for visualization of the needle. Lymph node biopsies can be additionally sampled for thyroglobulin assay to improve sensitivity for detection of recurrent carcinoma. Parathyroid FNA usually involves additional estimation of parathyroid hormone concentration in needle washouts. Biopsies of the neck are simple procedures with minimal complications.
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Affiliation(s)
- Nirvikar Dahiya
- Department of Radiology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
| | - Maitray D Patel
- Department of Radiology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Scott W Young
- Department of Radiology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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Ha EJ, Baek JH, Baek SM. Minimally Invasive Treatment for Benign Parathyroid Lesions: Treatment Efficacy and Safety Based on Nodule Characteristics. Korean J Radiol 2020; 21:1383-1392. [PMID: 32767864 PMCID: PMC7689148 DOI: 10.3348/kjr.2020.0037] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the efficacy and safety of ultrasound (US)-guided minimally invasive treatment in patients with parathyroid lesions. MATERIALS AND METHODS This study included 27 patients who had undergone US-guided radiofrequency ablation (RFA) or ethanol ablation (EA) for parathyroid lesions between January 2010 and 2018. RFA was performed in 19 patients with primary hyperparathyroidism (PHPT, n = 11) or secondary hyperparathyroidism (SHPT, n = 8), and EA was performed in eight patients with symptomatic nonfunctioning parathyroid cysts (SNPCs). Nodule size, volume, serum parathyroid hormone (PTH) and calcium levels were recorded before and after treatment. Complications were evaluated during and after treatment. RESULTS In patients with PHPT, significant reductions in size and volume were noted after RFA at 6- and 12-month follow-up (all, p < 0.05). Seven nodules nearly completely disappeared (residual volume < 0.1 mL); serum PTH and calcium levels were reduced to normal ranges (7/11, 63.6%). Four patients experienced partial reductions of serum PTH and calcium levels (4/11, 36.4%). In patients with SHPT, three experienced therapeutic response of serum PTH (3/8, 37.5%), while five showed persistent hyperparathyroidism (5/8, 62.5%) within 6 months after RFA. In patients with SNPCs, EA resulted in significant reductions in cyst size and volume (all, p < 0.05) at the last follow-up. A total of four complications (two transient hypocalcemia [RFA], one permanent [RFA], and one transient [EA] hoarseness) were observed. CONCLUSION Minimally invasive treatments, such as RFA and EA, may serve as therapeutic alternatives for patients with PHPT or SNPCs; they may have limited usefulness in patients with SHPT.
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Affiliation(s)
- Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Sun Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan, Korea
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