Selective venous sampling supports localization of adenoma in primary hyperparathyroidism.

Background: Selective venous sampling (SVS) is an invasive localization study for persistent or recurrent hyperparathyroidism.

Purpose: To assess the role of SVS in addition to non-invasive imaging for primary hyperparathyroidism (pHPT).

Material And Methods: This study was approved by the institutional review board and included 14 patients who underwent SVS and subsequent parathyroidectomy between January 2014 and April 2017 following a clinical diagnosis of pHPT. All patients underwent pre-SVS non-invasive imaging, including ultrasound, computed tomography (CT), and Tc-MIBI scintigraphy, and sensitivity was assessed using the operative and pathological findings.

Results: In all but one case, a single parathyroid adenoma was responsible for the pHPT; the remaining case exhibited a chemical response following surgical removal of parathyroid tissue. The sensitivity (%) for ultrasound, CT, Tc-MIBI scintigraphy, and SVS was 76.9, 84.6, 69.2, and 76.9, respectively. SVS yielded positive results in four patients with discordant results and one patient with non-detectable results on imaging. In seven patients, a significant increase in the intact parathyroid hormone level was recognized only in the thyroid veins. The procedure time was in the range of 52-183 min (median = 89.5 min).

Conclusion: The addition of SVS to a non-invasive imaging study would be helpful to locate the responsible lesion of pHPT with discordant or non-detectable results on imaging for initial surgical treatment as well.