Bilateral IJV Sampling for Parathyroid Adenoma Localization

Abstract

Objective: 1) Study the accuracy and utility of direct intraoperative internal jugular vein (IJV) sampling of parathyroid hormone (PTH) for localization of parathyroid adenoma. 2) Compare the accuracy of intraoperative IJV PTH sampling to that of preoperative Sestamibi scanning for lateralization. Method: A retrospective chart review of 51 consecutive neck explorations for primary hyperparathyroidism between 2007 and 2011. Direct bilateral IJV PTH sampling was performed prior to excision in all cases. Laterality based on IJV samples was compared with preoperative Sestamibi scans and operative findings. Results: There were no complications associated with sampling. 50 patients had single parathyroid adenomas, and 1 patient had ipsilateral double adenomas. All IJV sampling value difference was considered lateralizing. In 39 cases, IJV sampling successfully predicted laterality of adenoma, yielding a positive predictive value (PPV) of 76.5%. Sestamibi scans correctly lateralized in 37 cases (72.5%), 12 (23.5%) were nonlocalizing, and 2 (3.9%) were incorrect. PPV of Sestamibi scanning was 95%. IJV sampling successfully predicted the laterality of adenoma in 9 (75%) of the nonlocalizing Sestamibi scans and in 1 of the 2 incorrect scans. Conclusion: In patients with unilateral parathyroid adenomas, intraoperative bilateral IJV PTH sampling is a safe means of determining laterality of adenomas with a positive predictive value of 76.5%. This can be a valuable adjunct in cases where preoperative localization studies were unsuccessful or inaccurate in localizing the adenoma.