Abstract
Background
In recent years, four-dimensional computed tomography (4DCT) has emerged as a new localization study for primary hyperparathyroidism (pHPT).
Objective
We aimed to assess the added value of 4DCT in our institution in the first 4 years of use.
Methods
A retrospective cohort study was conducted from February 2004 to June 2015. Since 2011, patients over 50 years of age without concordant sestamibi-SPECT (SeS) and ultrasound (US) findings underwent 4DCT. Imaging results, surgical findings, histopathology, and postoperative biochemistry were collected.
Results
A total of 536 parathyroid operations in 510 patients were performed during the study period. The overall cure rate was 99.2% after reoperation in some patients, and the overall sensitivity for SeS was 76.0%, and 74.8% for US. Since 2011, 100 patients without concordant SeS/US findings have undergone 4DCT, with a sensitivity of 72.9%. This is in comparison to the sensitivities for SeS (48.3%) and US (52.3%). 4DCT was more sensitive in patients with persistent/recurrent disease (60.0% compared with SeS 43.8% and US 36.4%) and patients with multigland disease (67.4% compared with SeS 40.9% and US 42.1%). Comparison between outcomes in the pre- versus post-CT era demonstrated no difference in the initial cure rate (95.4 vs. 95.9%, p = 0.85) or the rate of minimally invasive parathyroidectomies (74.5 vs. 79.9%, p = 0.22).
Conclusion
Parathyroid 4DCT can aid surgical planning in cases without concordant SeS/US findings; however, the introduction of 4DCT as a second-line test did not change our overall cure rate or rate of minimally invasive parathyroidectomy. The role of 4DCT as the primary localization study for pHPT merits further investigation.
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References
Brown SJ, et al., Four-dimensional computed tomography for parathyroid localization: a new imaging modality. ANZ J Surg. 2015;85(6): 483–87.
Goldstein RE, et al. Effect of minimally invasive radioguided parathyroidectomy on efficacy, length of stay, and costs in the management of primary hyperparathyroidism. Ann Surg. 2000;231(5):732–42.
Rodgers SE, et al. Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery. 2006;140(6):932–40. discussion 940–41.
Chazen JL, et al. Diagnostic accuracy of 4D-CT for parathyroid adenomas and hyperplasia. AJNR Am J Neuroradiol. 2012;33(3):. 429–33.
Cheung K, et al. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol. 2012;19(2):577–83.
Kutler DI, et al. Parathyroid localization with modified 4D-computed tomography and ultrasonography for patients with primary hyperparathyroidism. Laryngoscope. 2011; 121(6):1219–24.
Mortenson MM, et al. Parathyroid exploration in the reoperative neck: improved preoperative localization with 4D-computed tomography. J Am Coll Surg. 2008; 206(5):888-95. discussion 895–96.
Seeliger B, et al. Diagnostic value and clinical impact of complementary CT scan prior to surgery for non-localized primary hyperparathyroidism. Langenbecks Arch Surg. 2015;400(3):307–12.
Kukar M, et al. The use of modified four-dimensional computed tomography in patients with primary hyperparathyroidism: an argument for the abandonment of routine sestamibi single-positron emission computed tomography (SPECT). Ann Surg Oncol. 2015;22(1):139–45.
Starker LF, et al. 4D parathyroid CT as the initial localization study for patients with de novo primary hyperparathyroidism. Ann Surg Oncol. 2011;18(6):1723–28.
Campbell MJ, et al. Two-phase (low-dose) computed tomography is as effective as 4D-CT for identifying enlarged parathyroid glands. Int J Surg. 2015;14:80–84.
Kebebew E, et al. Predictors of single-gland vs multigland parathyroid disease in primary hyperparathyroidism: a simple and accurate scoring model. Arch Surg. 2006; 141(8):777–82. discussion 782.
Noureldine SI, et al. Multiphase computed tomography for localization of parathyroid disease in patients with primary hyperparathyroidism: how many phases do we really need? Surgery. 2014;156(6):1300–06. discussion 13006–07.
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Tian, Y., Tanny, S.T., Einsiedel, P. et al. Four-Dimensional Computed Tomography: Clinical Impact for Patients with Primary Hyperparathyroidism. Ann Surg Oncol 25, 117–121 (2018). https://doi.org/10.1245/s10434-017-6115-9
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DOI: https://doi.org/10.1245/s10434-017-6115-9