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Annals of Surgical Oncology

, Volume 25, Issue 5, pp 1403–1409 | Cite as

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

  • Moska Hamidi
  • Michael Sullivan
  • George Hunter
  • Leena Hamberg
  • Nancy L. Cho
  • Atul A. Gawande
  • Gerard M. Doherty
  • Francis D. MooreJr.
  • Matthew A. Nehs
Endocrine Tumors

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.

Notes

Disclosure

None.

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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Moska Hamidi
    • 1
  • Michael Sullivan
    • 2
  • George Hunter
    • 3
  • Leena Hamberg
    • 4
  • Nancy L. Cho
    • 4
  • Atul A. Gawande
    • 4
  • Gerard M. Doherty
    • 4
  • Francis D. MooreJr.
    • 4
  • Matthew A. Nehs
    • 4
    • 5
  1. 1.Division of General SurgeryLondon Health Sciences CenterLondonCanada
  2. 2.Division of General SurgeryJersey Shore University Medical CenterNeptune CityUSA
  3. 3.Department of RadiologyMassachusetts General HospitalBostonUSA
  4. 4.Department of SurgeryBrigham and Women’s HospitalBostonUSA
  5. 5.General and Endocrine Surgery, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA

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