Korean Journal of Radiology

  • 제21권12호
  • /
  • Pages.1383-1392
  • /
  • 2020
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Minimally Invasive Treatment for Benign Parathyroid Lesions: Treatment Efficacy and Safety Based on Nodule Characteristics

  • Eun Ju Ha (Department of Radiology, Ajou University School of Medicine) ;
  • Jung Hwan Baek (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sun Mi Baek (Department of Radiology, Haeundae Sharing and Happiness Hospital)
  • 투고 : 2020.01.17
  • 심사 : 2020.04.24
  • 발행 : 2020.12.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: This study aimed to evaluate the efficacy and safety of ultrasound (US)-guided minimally invasive treatment in patients with parathyroid lesions. Materials and Methods: This study included 27 patients who had undergone US-guided radiofrequency ablation (RFA) or ethanol ablation (EA) for parathyroid lesions between January 2010 and 2018. RFA was performed in 19 patients with primary hyperparathyroidism (PHPT, n = 11) or secondary hyperparathyroidism (SHPT, n = 8), and EA was performed in eight patients with symptomatic nonfunctioning parathyroid cysts (SNPCs). Nodule size, volume, serum parathyroid hormone (PTH) and calcium levels were recorded before and after treatment. Complications were evaluated during and after treatment. Results: In patients with PHPT, significant reductions in size and volume were noted after RFA at 6- and 12-month follow-up (all, p < 0.05). Seven nodules nearly completely disappeared (residual volume < 0.1 mL); serum PTH and calcium levels were reduced to normal ranges (7/11, 63.6%). Four patients experienced partial reductions of serum PTH and calcium levels (4/11, 36.4%). In patients with SHPT, three experienced therapeutic response of serum PTH (3/8, 37.5%), while five showed persistent hyperparathyroidism (5/8, 62.5%) within 6 months after RFA. In patients with SNPCs, EA resulted in significant reductions in cyst size and volume (all, p < 0.05) at the last follow-up. A total of four complications (two transient hypocalcemia [RFA], one permanent [RFA], and one transient [EA] hoarseness) were observed. Conclusion: Minimally invasive treatments, such as RFA and EA, may serve as therapeutic alternatives for patients with PHPT or SNPCs; they may have limited usefulness in patients with SHPT.

키워드

참고문헌

  1. Fraser WD. Hyperparathyroidism. Lancet 2009;374:145-158 https://doi.org/10.1016/S0140-6736(09)60507-9
  2. Huppert BJ, Reading CC. Parathyroid sonography: imaging and intervention. J Clin Ultrasound 2007;35:144-155 https://doi.org/10.1002/jcu.20311
  3. Sung JY, Baek JH, Kim KS, Lee D, Ha EJ, Lee JH. Symptomatic nonfunctioning parathyroid cysts: role of simple aspiration and ethanol ablation. Eur J Radiol 2013;82:316-320 https://doi.org/10.1016/j.ejrad.2012.10.009
  4. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl (2011) 2017;7:1-59 https://doi.org/10.1016/j.kisu.2017.04.001
  5. Jinih M, O'Connell E, O'Leary DP, Liew A, Redmond HP. Focused versus bilateral parathyroid exploration for primary hyperparathyroidism: a systematic review and meta-analysis. Ann Surg Oncol 2017;24:1924-1934 https://doi.org/10.1245/s10434-016-5694-1
  6. Korkusuz H, Wolf T, Grunwald F. Feasibility of bipolar radiofrequency ablation in patients with parathyroid adenoma: a first evaluation. Int J Hyperthermia 2018;34:639-643 https://doi.org/10.1080/02656736.2018.1453552
  7. Sormaz IC, Poyanli A, Acar S, I ˙s,can AY, Ozgur I, Tunca F, et al. The results of ultrasonography-guided percutaneous radiofrequency ablation in hyperparathyroid patients in whom surgery is not feasible. Cardiovasc Intervent Radiol 2017;40:596-602 https://doi.org/10.1007/s00270-016-1544-6
  8. Kim BS, Eom TI, Kang KH, Park SJ. Radiofrequency ablation of parathyroid adenoma in primary hyperparathyroidism. J Med Ultrason (2001) 2014;41:239-243 https://doi.org/10.1007/s10396-013-0501-0
  9. Xu SY, Wang Y, Xie Q, Wu HY. Percutaneous sonography-guided radiofrequency ablation in the management of parathyroid adenoma. Singapore Med J 2013;54:e137-e140 https://doi.org/10.11622/smedj.2013092
  10. Fan BQ, He XW, Chen HH, Zhang WM, Tang W. US-guided microwave ablation for primary hyperparathyroidism: a safety and efficacy study. Eur Radiol 2019;29:5607-5616 https://doi.org/10.1007/s00330-019-06078-y
  11. Liu C, Wu B, Huang P, Ding Q, Xiao L, Zhang M, et al. US-guided percutaneous microwave ablation for primary hyperparathyroidism with parathyroid nodules: feasibility and safety study. J Vasc Interv Radiol 2016;27:867-875 https://doi.org/10.1016/j.jvir.2016.02.013
  12. Cao XL, Cheng ZG, Yu XL, Han ZY, Liang P. Ultrasound-guided percutaneous microwave ablation of parathyroid adenoma. J Vasc Interv Radiol 2016;27:1929-1931 https://doi.org/10.1016/j.jvir.2016.08.021
  13. Liu F, Yu X, Liu Z, Qiao Z, Dou J, Cheng Z, et al. Comparison of ultrasound-guided percutaneous microwave ablation and parathyroidectomy for primary hyperparathyroidism. Int J Hyperthermia 2019;36:835-840 https://doi.org/10.1080/02656736.2019.1645365
  14. Kovatcheva RD, Vlahov JD, Shinkov AD, Borissova AM, Hwang JH, Arnaud F, et al. High-intensity focused ultrasound to treat primary hyperparathyroidism: a feasibility study in four patients. AJR Am J Roentgenol 2010;195:830-835 https://doi.org/10.2214/AJR.09.3932
  15. Kovatcheva R, Vlahov J, Stoinov J, Lacoste F, Ortuno C, Zaletel K. US-guided high-intensity focused ultrasound as a promising non-invasive method for treatment of primary hyperparathyroidism. Eur Radiol 2014;24:2052-2058 https://doi.org/10.1007/s00330-014-3252-4
  16. Ambrosini CE, Cianferotti L, Picone A, Torregrossa L, Segnini G, Frustaci G, et al. High-intensity focused ultrasound as an alternative to the surgical approach in primary hyperparathyroidism: a preliminary experience. J Endocrinol Invest 2011;34:655-659 https://doi.org/10.1007/BF03345404
  17. Diao Z, Liu X, Qian L, Liu J, Liu S, Liu W. Efficacy and its predictor in microwave ablation for severe secondary hyperparathyroidism in patients undergoing haemodialysis. Int J Hyperthermia 2016;32:614-622 https://doi.org/10.1080/02656736.2016.1194485
  18. Diao Z, Wang L, Li D, Liu W. Efficacy of microwave ablation for severe secondary hyperparathyroidism in subjects undergoing hemodialysis. Ren Fail 2017;39:140-145 https://doi.org/10.1080/0886022X.2016.1256307
  19. Zhao J, Qian L, Zu Y, Wei Y, Hu X. Efficacy of ablation therapy for secondary hyperparathyroidism by ultrasound guided percutaneous thermoablation. Ultrasound Med Biol 2016;42:1058-1065 https://doi.org/10.1016/j.ultrasmedbio.2015.08.021
  20. Zhuo L, Peng LL, Zhang YM, Xu ZH, Zou GM, Wang X, et al. US-guided microwave ablation of hyperplastic parathyroid glands: safety and efficacy in patients with end-stage renal disease-a pilot study. Radiology 2017;282:576-584 https://doi.org/10.1148/radiol.2016151875
  21. Zhuo L, Zhang L, Peng LL, Yang Y, Lu HT, Chen DP, et al. Microwave ablation of hyperplastic parathyroid glands is a treatment option for end-stage renal disease patients ineligible for surgical resection. Int J Hyperthermia 2019;36:29-35 https://doi.org/10.1080/02656736.2018.1528392
  22. Wang G, Liu S, Liu X, Qian L, Diao Z, Liu W. Microwave ablation: an effective treatment for mild-to-moderate secondary hyperparathyroidism in patients undergoing haemodialysis. Int J Hyperthermia 2017;33:946-952 https://doi.org/10.1080/02656736.2017.1357210
  23. Jiang T, Chen F, Zhou X, Hu Y, Zhao Q. Percutaneous ultrasound-guided laser ablation with contrast-enhanced ultrasonography for hyperfunctioning parathyroid adenoma: a preliminary case series. Int J Endocrinol 2015;2015:673604
  24. Andrioli M, Riganti F, Pacella CM, Valcavi R. Long-term effectiveness of ultrasound-guided laser ablation of hyperfunctioning parathyroid adenomas: present and future perspectives. AJR Am J Roentgenol 2012;199:1164-1168 https://doi.org/10.2214/AJR.11.8442
  25. Li X, An C, Yu M, Peng L. US-guided microwave ablation for secondary hyperparathyroidism in patients after renal transplantation: a pilot study. Int J Hyperthermia 2019;36:322-327 https://doi.org/10.1080/02656736.2019.1566580
  26. Jiang B, Wang X, Yao Z, Wu H, Xiao L, Gong H, et al. Microwave ablation vs. parathyroidectomy for secondary hyperparathyroidism in maintenance hemodialysis patients. Hemodial Int 2019;23:247-253 https://doi.org/10.1111/hdi.12740
  27. Peng C, Zhang Z, Liu J, Chen H, Tu X, Hu R, et al. Efficacy and safety of ultrasound-guided radiofrequency ablation of hyperplastic parathyroid gland for secondary hyperparathyroidism associated with chronic kidney disease. Head Neck 2017;39:564-571 https://doi.org/10.1002/hed.24657
  28. Ippolito G, Palazzo FF, Sebag F, Sierra M, De Micco C, Henry JF. A single-institution 25-year review of true parathyroid cysts. Langenbecks Arch Surg 2006;391:13-18 https://doi.org/10.1007/s00423-005-0579-y
  29. Kodama T, Obara T, Fujimoto Y, Ito Y, Yashiro T, Hirayama A. Eleven cases of nonfunctioning parathyroid cyst--significance of needle aspiration in diagnosis and management. Endocrinol Jpn 1987;34:769-777 https://doi.org/10.1507/endocrj1954.34.769
  30. Prinz RA, Peters JR, Kane JM, Wood J. Needle aspiration of nonfunctioning parathyroid cysts. Am Surg 1990;56:420-422
  31. Shi B, Guo H, Tang N. Treatment of parathyroid cysts with fine-needle aspiration. Ann Intern Med 1999;131:797-798 https://doi.org/10.7326/0003-4819-131-10-199911160-00035
  32. Ha EJ, Baek JH, Lee JH. Ultrasonography-based thyroidal and perithyroidal anatomy and its clinical significance. Korean J Radiol 2015;16:749-766
  33. Xiaoyin T, Ping L, Dan C, Min D, Jiachang C, Tao W, et al. Risk assessment and hydrodissection technique for radiofrequency ablation of thyroid benign nodules. J Cancer 2018;9:3058-3066 https://doi.org/10.7150/jca.26060
  34. Park HS, Baek JH, Park AW, Chung SR, Choi YJ, Lee JH. Thyroid radiofrequency ablation: updates on innovative devices and techniques. Korean J Radiol 2017;18:615-623 https://doi.org/10.3348/kjr.2017.18.4.615