DOI:10.2214/AJR.07.3074
AJR 2008; 190:W83
© American Roentgen Ray Society
Reply
Mitchell E. Tublin,
Nathan A. Johnson and
Jennifer B. Ogilvie
University of Pittsburgh Medical Center and School of Medicine,
Pittsburgh, PA 15213
WEB—This is a Web exclusive article.
We thank Dr. Buckley and colleagues
[1] for their letter and
thoughtful comments. The authors correctly point out the diagnostic potential
of selective venous sampling. Fortunately, the accuracy of abnormal
parathyroid localization with well-performed traditional techniques
(sonography and 99mTc-sestamibi) has decreased the clinical
relevance of venous sampling. Indeed, in our opinion, selective venous
sampling has no role in the imaging evaluation of those patients with primary
hyperparathyroidism who are being evaluated for initial minimally invasive
parathyroidectomy.
Selective venous sampling is a labor-intensive, invasive test with
potential complications. In addition, it is important to remember that
selective venous sampling provides functional data that implicates a region of
increased parathyroid hormone production but does not directly image the
abnormal gland(s), as do sonography, sestamibi, CT, and MRI. Thus, its utility
in differentiating between parathyroid adenomas and lymph nodes is limited. A
more direct approach to this diagnostic dilemma is sonographically guided
parathyroid hormone sampling; such an approach has been shown to detect
parathyroid tissue with a sensitivity of 100%
[2,
3].
Selective venous sampling, however, can be very helpful in the evaluation
of a small, select subset of patients with recurrent or persistent
hyperparathyroidism, with a true-positive rate of 71-90%
[4-6].
Even in this setting, the procedure is often not performed because of the
technical difficulty of accessing and aspirating blood samples from small
cervical or mediastinal veins.
We applaud the authors for their description of a novel technique using a
microwire system to facilitate selective catheterization and look forward to
future studies showing its effectiveness relative to standard techniques.
References
- Buckley O, Halpenny D, Torreggiani WC. Role of the radiologist in
the preoperative evaluation of primary hyperparathyroidism. (letter)
AJR 2008;190
:[web]W82
- Erbil Y, Barbaros U, Salmaslioglu A, et al. Value of parathyroid
hormone assay for preoperative sonographically guided parathyroid aspirates
for minimally invasive parathyroidectomy. J Clin
Ultrasound 2006; 34:425
-429[CrossRef][Medline]
- Erbil Y, Salmaslioglu A, Kabul E, et al. Use of preoperative
parathyroid fine-needle aspiration and parathormone assay in primary
hyperparathyroidism with concomitant thyroid nodules. Am J
Surg 2007; 193:665
-671[CrossRef][Medline]
- Jones JJ, Brunaud L, Dowd CF, Duh QY, Morita E, Clark OH. Accuracy
of selective venous sampling for intact parathyroid hormone in difficult
patients with recurrent or persistent hyperparathyroidism.
Surgery 2002; 132:944
-950; discussion 950-951[CrossRef][Medline]
- Seehofer D, Steinmüller T, Rayes N, et al. Parathyroid hormone
venous sampling before reoperative surgery in renal hyperparathyroidism:
comparison with noninvasive localization procedures and review of the
literature. Arch Surg 2004;139
: 1331-1338[Abstract/Free Full Text]
- Reidel MA, Schilling T, Graf S, et al. Localization of
hyperfunctioning parathyroid glands by selective venous sampling in
reoperation for primary or secondary hyperparathyroidism.
Surgery 2006; 140:907
-913; discussion 913[CrossRef][Medline]
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