The role of selective venous sampling in patients with non-localized primary hyperparathyroidism
İlhan Gök1, Nuri Alper Şahbaz2, Cevher Akarsu2, Ahmet Cem Dural2, Meral Mert3, Fatma Aysun Erbahçeci Salık4, Barbaros Erhan Çil4, Deniz Güzey2, Halil Alış5
1Department of General Surgery, Buyukcekmece Mimar Sinan State Hospital, Istanbul, Turkey
2Department of General Surgery, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
3Department of Endocrinology and Metabolism, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
4Department of Interventional Radiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
5Department of General Surgery, İ.A.Ü. VM Medical Park Florya Hospital, Istanbul, Turkey
Objective: The aim of this observational clinical study was to evaluate the success of angiographic selective venous sampling (ASVS) in locating parathyroid adenoma in patients with primary hyperparathyroidism (PHPT), in whom the other imaging modalities have failed, and and to evaluate its possible contribution to the applicability of minimal invasive surgery.
Material and Methods: Fifty-five patients who were admitted to our hospital’s General Surgery department between January 2012 and January 2015 for PHPT in whom ultrasound and sestamibi scintigraphy have failed to localize the diseased gland were included to the study. Patients were divided into two groups: those who underwent ASVS and those who did not. The outcomes of patients were reviewed retrospectively.
Results: Among 55 patients, 20 underwent ASVS. ASVS successfully lateralized the diseased gland in 17 (85%) patients, and minimally invasive parathyroidectomy could be performed in 14 (70%) patients. The cut-off value of parathormon gradient was considered 10% for lateralization and the accuracy of ASVS in lateralization was 94.1%. In 11 (59%) patients, the superior-inferior discrimination could be achieved in addition to lateralization.
Conclusion: ASVS has a high sensitivity in locating the diseased gland in patients with PHPT in whom ultrasound and sestamibi scan have failed, and thereby, rendering the performance of minimally invasive surgery possible. Further studies may reveal the role of ASVS in providing useful information about not only lateralization but also the superior-inferior discrimination.
Keywords: Primary hyperparathyridism, parathyroid adenoma, selective venous sampling
Prior to the study, ethics approval was obtained from the local ethics committee (Nr: 2014.13.11, Date: October 10th, 2014).
Informed consent form was obtained from all patients.
Concept – C.A., İ.G., H.A.; Design – C.A., M.M., F.A.E.S.; Supervision – H.A., M.M., B.E.Ç., D.G.; Data Collection and/or Processing – İ.G., N.A.Ş., F.A.E.S., D.G.; Analysis and Interpretation – A.C.D., C.A., M.M., N.A.Ş.; Literature Review – D.G., İ.G., B.E.Ç.; Writing Manuscript – İ.G., A.C.D., N.A.Ş., F.A.E.S.; Critical Reviews – H.A., A.C.D., B.E.Ç.
The authors have no conflicts of interest.
Financial support was provided by departmental sources.