Selda GÜCEK HACİYANLI, Mehmet HACİYANLI, Ömür BALLI, Nezahat ERDOĞAN, Nihan ACAR

Selective venous sampling in primary hyperparathyroidism: Is it worth doing?

Background/aim: Accurate preoperative localization of the culprit gland is the key point for the surgical treatment of primary hyperparathyroidism. Conventional imaging techniques (ultrasound and Tc99m sestamibi scintigraphy) are usually adequate for preoperative localization. However, in some patient groups, additional imaging modalities may be required since noninvasive techniques may fail. In this study, we aimed to evaluate the diagnostic value of selective parathyroid venous sampling in patients with unclear noninvasive localization tests. Materials and methods: Among 513 cases who underwent parathyroidectomy due to primary hyperparathyroidism, twelve cases (2.3%) were undergone selective parathyroid venous sampling and were included in the study. Age, sex, presenting symptom, presence of a genetic disease, medical and surgical history, serum calcium (Ca)-parathormone (PTH) levels (preoperative, intraoperative, and postoperative), imaging reports (US, SM, and SVS), surgery reports, pathology reports, and complications were retrospectively reviewed. Results: Seven cases (58.3%) had persistent primary hyperparathyroidism and one patient (8.3%) had past surgical history of total thyroidectomy. The remaining four patients (33.3%) had no previous neck surgery. The sensitivity of selective venous sampling was 75%. According to the medical history, accurate localization was achieved in 85.7% of persistent cases and 60% of primary cases. Eight cases (66.6%) underwent unilateral neck exploration and four cases (33.3%) underwent four gland exploration. A single adenoma was detected in ten cases (90.9%) while one patient (9.1%) had double adenoma. Conclusion: Selective venous sampling is a prominent technique with high accuracy in persistent cases when the conventional imaging methods are negative or equivocal. Although the cost and invasiveness are the most common confusing facts about selective venous sampling, its benefits such as improving the surgical success and saving the patients from repeated operations may surpass them.

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1. Mohebati A, Shaha AR. Imaging techniques in parathyroid surgery for primary hyperparathyroidism. American Journal of Otolaryngology 2012; 33 (4): 457–468. doi: 10.1016/j. amjoto.2011.10.010
2.Noureldine SI, Gooi Z, Tufano RP. Minimally invasive parathyroid surgery. Gland Surgery 2015; 4 (5): 410–419.doi: 10.3978/j. issn.2227-684X.2015.03.07
3. Habibollahi P, Shin B, Shamchi SP, Wachtel H, Fraker DL et al. Eleven-year retrospective report of super-selective venous sampling for the evaluation of recurrent or persistent hyperparathyroidism in 32 patients. CardioVascular and Interventional Radiology 2018 ; 41(1): 63-72. doi: 10.1007/ s00270-017-1757-3
4. Hader C, Uder M, Loose RW, Linnemann U, Bertsch T et al. Selective venous blood sampling for hyperparathyroidism with unclear localization of the parathyroid gland. Röfo 2016 ;188 (12): 1144-1150. doi: 10.1055/s-0042-113613
5. Rodgers SE, Hunter GJ, Hamberg LM, Schellingerhout D, Doherty DB et al. Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery 2006; 140 (6): 932–940. doi: 10.1016/j. surg.2006.07.028
6. Grayev AM, Gentry LR, Hartman MJ, Chen H, Perlman SB et al. Presurgical localization of parathyroid adenomas with magnetic resonance imaging at 3.0 T: an adjunct method to supplement traditional imaging. Annals of Surgical Oncology 2012; 19 (3): 981–989.doi: 10.1245/s10434-011-2046-z
7. Yamada T, Ikuno M, Shinjo Y, Hiroishi A, Matsushita S et al. Selective venous sampling for primary hyperparathyroidism: how to perform an examination and interpret the results with reference to thyroid vein anatomy. Japanese Journal of Radiology 2017; 35 (8): 409-416. doi: 10.1007/s11604-017- 0658-3
8. Seehofer D, Steinmüller T, Rayes N, Podrabsky P, Riethmüller J et al. Parathyroid hormone venous sampling before reoperative surgery in renal hyperparathyroidism: comparison with noninvasive localization procedures and review of the literature. The Archives of Surgery 2004; 139 (12):1331-1338. doi: 10.1001/archsurg.139.12.1331
9. Irvin GL 3rd, Dembrow VD, Prudhomme DL. Clinical usefulness of an intraoperative quick parathyroid hormone assay. Surgery 1993;114 (6): 1019-1023.
10. Berber E, Parikh RT, Ballem N, Garner CN, Milas M et al. Factors contributing to negative parathyroid localization: an analysis of 1000 patients. Surgery 2008; 144 (1):74-79. doi: 10.1016/j. surg.2008.03.019
11. Calò PG, Medas F, Loi G, Erdas E, Pisano G et al. Feasibility of unilateral parathyroidectomy in patients with primary hyperparathyroidism and negative or discordant localization studies. Updates in Surgery 2016; 68 (2):155-161. doi: 10.1007/ s13304-015-0342-z
12. Sun PY, Thompson SM, Andrews JC, Wermers RA, McKenzie TJ et al. Selective parathyroid hormone venous sampling in patients with persistent or recurrent primary hyperparathyroidism and negative, equivocal or discordant noninvasive imaging. World Journal of Surgery 2016; 40 (12): 2956–2963.doi: 10.1007/ s00268-016-3621-z
13. Zolin SJ, Crawford K, Rudin AV, Harsono H, Krishnamurthy VD et al. Selective parathyroid venous sampling in reoperative parathyroid surgery: A key localization tool when noninvasive tests are unrevealing. Surgery 2021; 169(1): 126-132. doi: 10.1016/j.surg.2020.05.014
14. Ikuno M, Yamada T, Shinjo Y, Morimoto T, Kumano R et al. Selective venous sampling supports localization of adenoma in primary hyperparathyroidism. Acta Radiologica Open 2018; 7 (2): 2058460118760361. doi: 10.1177/2058460118760361
15. Doppman JL.Parathyroid localization: arteriography and venous sampling. Radiologic Clinics of North America 1976; 14 (2): 163-188.
16. Reidel MA, Schilling T, Graf S, Hinz U, Nawroth P et al. Localization of hyperfunctioning parathyroid glands by selective venous sampling in reoperation for primary or secondary hyperparathyroidism. Surgery 2006; 140 (6):907- 913. doi: 10.1016/j.surg.2006.06.037
17. Prescott JD, Udelsman R. Remedial operation for primary hyperparathyroidism. World Journal of Surgery 2009; 33 (11):2324-2334. doi: 10.1007/s00268-009-9962-0
18. Ibraheem K, Toraih EA, Haddad AB, Farag M, Randolph GW et al. Selective parathyroid venous sampling in primary hyperparathyroidism: A systematic review and meta-analysis. Laryngoscope 2018; 128 (11): 2662-2667. doi: 10.1002/ lary.27213
19. Ginsburg M, Christoforidis GA, Zivin SP, Obara P, Wroblewski K et al. Adenoma localization for recurrent or persistent primary hyperparathyroidism using dynamic four-dimensional CT and venous sampling. Journal of Vascular and Interventional Radiology 2015; 26 (1): 79–86.doi: 10.1016/j.jvir.2014.09.019