Parathyroid carcinoma: impact of preoperative diagnosis on the choice of surgical procedure
The operative procedure in the surgical treatment of parathyroid carcinoma differs from that of benign hyperparathyroidism. However, preoperative differentiation is often difficult. This study elucidated how clinicians diagnose parathyroid carcinoma and the relationship between preoperative diagnosi...
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| Format: | Article |
| Language: | English |
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The Japan Endocrine Society
2023-10-01
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| Series: | Endocrine Journal |
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| Online Access: | https://www.jstage.jst.go.jp/article/endocrj/70/10/70_EJ23-0149/_html/-char/en |
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| author | Yoshitaka Kawai Yo Kishimoto Hisanobu Tamaki Takashi Fujiwara Ryo Asato Koji Ushiro Shogo Shinohara Shinpei Kada Shinji Takebayashi Tsuyoshi Kojima Shuya Otsuki Masakazu Miyazaki Yohei Kumabe Koichi Omori |
| author_facet | Yoshitaka Kawai Yo Kishimoto Hisanobu Tamaki Takashi Fujiwara Ryo Asato Koji Ushiro Shogo Shinohara Shinpei Kada Shinji Takebayashi Tsuyoshi Kojima Shuya Otsuki Masakazu Miyazaki Yohei Kumabe Koichi Omori |
| author_sort | Yoshitaka Kawai |
| collection | DOAJ |
| description | The operative procedure in the surgical treatment of parathyroid carcinoma differs from that of benign hyperparathyroidism. However, preoperative differentiation is often difficult. This study elucidated how clinicians diagnose parathyroid carcinoma and the relationship between preoperative diagnosis and the operative course. Using a retrospective chart review, twenty cases of parathyroid carcinoma from nine participating centers were examined. In 11 cases with preoperative suspicion of malignancy, at least one of these three features was found: elevated serum calcium level (>14 mg/dL), palpable mass, and irregular margin on ultrasonography. Although an intact parathyroid hormone (iPTH) threshold to suspect malignancy has not been established, six cases showed marked iPTH elevation exceeding 8.0 times the upper limit of normal. One case was excluded from analysis due to hemodialysis. Compared with the four cases that showed calcium elevation, the iPTH threshold might represent better sensitivity. Among 9 cases of benign preoperative diagnosis, six cases were performed with pericapsular resection. In three cases where malignancy was suspected in the middle of the operation, the recommended en bloc resection with ipsilateral thyroid lobectomy was not performed but a parathyroidectomy with surrounding soft tissue. In contrast, 10 preoperatively suspected cases underwent en bloc resection, and one case underwent pericapsular resection followed by supplementary ipsilateral hemithyroidectomy due to the uncertain pre- and intraoperative findings to determine the diagnosis. In conclusion, the surgical procedure for parathyroid carcinoma strongly depends on the preoperative diagnosis. The presence of excessive iPTH levels might contribute to improved preoperative diagnostic sensitivity for parathyroid carcinoma. |
| format | Article |
| id | doaj-art-5c021793b9e54992a82156186191c2ae |
| institution | Kabale University |
| issn | 1348-4540 |
| language | English |
| publishDate | 2023-10-01 |
| publisher | The Japan Endocrine Society |
| record_format | Article |
| series | Endocrine Journal |
| spelling | doaj-art-5c021793b9e54992a82156186191c2ae2025-01-22T06:19:20ZengThe Japan Endocrine SocietyEndocrine Journal1348-45402023-10-01701096997610.1507/endocrj.EJ23-0149endocrjParathyroid carcinoma: impact of preoperative diagnosis on the choice of surgical procedureYoshitaka Kawai0Yo Kishimoto1Hisanobu Tamaki2Takashi Fujiwara3Ryo Asato4Koji Ushiro5Shogo Shinohara6Shinpei Kada7Shinji Takebayashi8Tsuyoshi Kojima9Shuya Otsuki10Masakazu Miyazaki11Yohei Kumabe12Koichi Omori13Department of Otolaryngology - Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, JapanDepartment of Otolaryngology - Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, JapanDepartment of Otolaryngology - Head and Neck Surgery, Kurashiki Central Hospital, Okayama 710-8602, JapanDepartment of Otolaryngology - Head and Neck Surgery, Kurashiki Central Hospital, Okayama 710-8602, JapanDepartment of Otolaryngology - Head & Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto 612-0861, JapanDepartment of Otolaryngology - Head & Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto 612-0861, JapanDepartment of Otolaryngology - Head & Neck Surgery, Kobe City Medical Center General Hospital, Hyogo 650-0047, JapanDepartment of Otolaryngology, Japanese Red Cross Otsu Hospital, Shiga 520-0046, JapanDepartment of Otorhinolaryngology - Head and Neck Surgery, Shiga General Hospital, Shiga 524-8524, JapanDepartment of Otolaryngology - Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, JapanDepartment of Otolaryngology, Tenri Hospital, Nara 632-0015, JapanDepartment of Head and Neck Surgery, Nara Prefecture General Medical Center, Nara 630-8581, JapanDepartment of Otolaryngology - Head & Neck Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo 660-8550, JapanDepartment of Otolaryngology - Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, JapanThe operative procedure in the surgical treatment of parathyroid carcinoma differs from that of benign hyperparathyroidism. However, preoperative differentiation is often difficult. This study elucidated how clinicians diagnose parathyroid carcinoma and the relationship between preoperative diagnosis and the operative course. Using a retrospective chart review, twenty cases of parathyroid carcinoma from nine participating centers were examined. In 11 cases with preoperative suspicion of malignancy, at least one of these three features was found: elevated serum calcium level (>14 mg/dL), palpable mass, and irregular margin on ultrasonography. Although an intact parathyroid hormone (iPTH) threshold to suspect malignancy has not been established, six cases showed marked iPTH elevation exceeding 8.0 times the upper limit of normal. One case was excluded from analysis due to hemodialysis. Compared with the four cases that showed calcium elevation, the iPTH threshold might represent better sensitivity. Among 9 cases of benign preoperative diagnosis, six cases were performed with pericapsular resection. In three cases where malignancy was suspected in the middle of the operation, the recommended en bloc resection with ipsilateral thyroid lobectomy was not performed but a parathyroidectomy with surrounding soft tissue. In contrast, 10 preoperatively suspected cases underwent en bloc resection, and one case underwent pericapsular resection followed by supplementary ipsilateral hemithyroidectomy due to the uncertain pre- and intraoperative findings to determine the diagnosis. In conclusion, the surgical procedure for parathyroid carcinoma strongly depends on the preoperative diagnosis. The presence of excessive iPTH levels might contribute to improved preoperative diagnostic sensitivity for parathyroid carcinoma.https://www.jstage.jst.go.jp/article/endocrj/70/10/70_EJ23-0149/_html/-char/enparathyroid carcinomahyperparathyroidismpreoperative diagnosissurgical planning |
| spellingShingle | Yoshitaka Kawai Yo Kishimoto Hisanobu Tamaki Takashi Fujiwara Ryo Asato Koji Ushiro Shogo Shinohara Shinpei Kada Shinji Takebayashi Tsuyoshi Kojima Shuya Otsuki Masakazu Miyazaki Yohei Kumabe Koichi Omori Parathyroid carcinoma: impact of preoperative diagnosis on the choice of surgical procedure Endocrine Journal parathyroid carcinoma hyperparathyroidism preoperative diagnosis surgical planning |
| title | Parathyroid carcinoma: impact of preoperative diagnosis on the choice of surgical procedure |
| title_full | Parathyroid carcinoma: impact of preoperative diagnosis on the choice of surgical procedure |
| title_fullStr | Parathyroid carcinoma: impact of preoperative diagnosis on the choice of surgical procedure |
| title_full_unstemmed | Parathyroid carcinoma: impact of preoperative diagnosis on the choice of surgical procedure |
| title_short | Parathyroid carcinoma: impact of preoperative diagnosis on the choice of surgical procedure |
| title_sort | parathyroid carcinoma impact of preoperative diagnosis on the choice of surgical procedure |
| topic | parathyroid carcinoma hyperparathyroidism preoperative diagnosis surgical planning |
| url | https://www.jstage.jst.go.jp/article/endocrj/70/10/70_EJ23-0149/_html/-char/en |
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