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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2018

01-05-2018 | Endocrine Tumors

4D-CT is Superior to Ultrasound and Sestamibi for Localizing Recurrent Parathyroid Disease

Authors: Moska Hamidi, MD, Michael Sullivan, MD, George Hunter, MD, Leena Hamberg, PhD, Nancy L. Cho, MD, Atul A. Gawande, MD, Gerard M. Doherty, MD, Francis D. Moore Jr., MD, Matthew A. Nehs, MD

Published in: Annals of Surgical Oncology | Issue 5/2018

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Abstract

Background

Recurrent primary hyperparathyroidism (PHPT) presents a diagnostic challenge in localizing a hyperfunctioning gland. Although several imaging modalities are available for preoperative localization, 4D-CT is increasingly utilized for its ability to locate both smaller and previously unlocalized lesions. Currently, there is a paucity of data evaluating the utility of 4D-CT in the reoperative setting compared with ultrasound (US) and sestamibi. We aimed to determine the sensitivity of 4D-CT in localizing parathyroid adenomas in recurrent or persistent PHPT.

Methods

We performed a retrospective review of prospectively collected data from a tertiary-care hospital, and identified 58 patients who received preoperative 4D-CT with US and/or sestamibi between May 2008 and March 2016. Data regarding the size, shape, and number of parathyroid lesions were collected for each patient.

Results

A total of 62 lesions were identified intraoperatively among the 58 patients (6 with multigland disease) included in this investigation. 4D-CT missed 13 lesions identified intraoperatively, compared with 32 and 22 lesions missed by US and sestamibi, respectively. Sensitivity for correct lateralization of culprit lesions was 77.4% for 4D-CT, 38.5% for US, and 46% for sestamibi. 4D-CT was superior in lateralizing adenomas (49/62) compared with US (20/52; p < 0.001) and sestamibi (18/47; p < 0.001). The overall cure rate (6-month postoperative calcium < 10.7 mg/dL) was 89.7%. All patients with lesions correctly lateralized by 4D-CT were cured at 6 months.

Conclusion

4D-CT localized parathyroid adenomas with higher sensitivity among patients with recurrent or persistent PHPT compared with sestamibi or US-based imaging.
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Metadata
Title
4D-CT is Superior to Ultrasound and Sestamibi for Localizing Recurrent Parathyroid Disease
Authors
Moska Hamidi, MD
Michael Sullivan, MD
George Hunter, MD
Leena Hamberg, PhD
Nancy L. Cho, MD
Atul A. Gawande, MD
Gerard M. Doherty, MD
Francis D. Moore Jr., MD
Matthew A. Nehs, MD
Publication date
01-05-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6367-z

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