Largest Single-Institution Case Series of Resection of SPECT-CT Localized Mediastinal Parathyroid Adenomas
Presented During:
Sunday, May 4, 2025: 9:00AM - 4:00PM
Seattle Convention Center | Summit
Posted Room Name:
Poster Area, Exhibit Hall
Abstract No:
P0178
Submission Type:
Abstract Submission
Authors:
Crystal Zhang (1), Amanda Shelowitz (1), Andi Diamond (1), Mary Carolyn Vinson (1), Jonathan Daniel (1), Eric Sommers (1)
Institutions:
(1) Tampa General Hospital, Tampa, FL
Submitting Author:
Crystal Zhang
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Tampa General Hospital
Tampa General Hospital
Co-Author(s):
Amanda Shelowitz
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Tampa General Hospital
Tampa General Hospital
Andi Diamond
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Tampa General Hospital
Tampa General Hospital
Mary Carolyn Vinson
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Tampa General Hospital
Tampa General Hospital
Jonathan Daniel
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Tampa General Hospital
Tampa General Hospital
Eric Sommers
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Tampa General Hospital
Tampa General Hospital
Presenting Author:
Crystal Zhang
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Franciscan Health Indianapolis
Franciscan Health Indianapolis
Abstract:
Objective: Mediastinal parathyroid adenomas (MPAs) are challenging to locate and resect, but single-photon emission CT with CT (SPECT-CT) has high sensitivity and specificity for localizing MPAs. The objective of this study is to characterize the thoracic surgical approach based on localization by SPECT-CT and assess success rate of resection by biochemical resolution of hyperparathyroidism (HPT).
Methods: A retrospective review of 73 patients who underwent resection of MPAs localized on SPECT-CT at a quaternary institution from 2017 to 2024 was performed. Descriptive statistics were used to analyze demographics, symptoms, lab values, imaging findings, operative details, and postoperative (post-op) courses. The Student's t-test was used to analyze the difference between the parathyroid hormone (PTH) and calcium (CA) levels before and after surgery.
Results: The majority were female with ages ranging 17-84. All but two patients (97%) were symptomatic preoperatively (pre-op) with almost half experiencing fatigue, neurocognitive symptoms, or bone and muscle pain, and about a third had nephrolithiasis. Almost all had prior operations, and a quarter had multiple prior surgeries. All had positive SPECT-CT localization pre-op with 60% in the left infra-innominate thymus, 28% in the right infra-innominate thymus, 8% in the aortopulmonary (PA) window, 3% in the right supra-innominate thymus, and 1% in the tracheoesophageal (TE) groove. All infra-innominate adenomas were approached supine with three robotic trocars. The six PA window and one TE groove adenoma were approached in the lateral decubitus position robotically or via an axillary thoracotomy. Partial sternotomy was used for both supra-innominate adenomas. There were six patients that did not have parathyroid tissue identified on pathology. However, despite this, all patients who underwent tissue resection had normalization of post-op PTH and CA. The average pre-op PTH was 195 and was reduced to 30 post-op (p<0.01). Similarly, average pre-op CA was 11 and dropped to 9 post-op (p<0.01). One case was aborted secondary to PA hematoma, four patients had self-limiting post-op complications, and 1 patient had vocal cord immobility requiring injection. There were no mortalities (Table).
Conclusions: SPECT-CT was able to localize 100% of the mediastinal parathyroid adenomas preoperatively, which guided the operative approach with 100% success in normalizing PTH and CA after adenoma resection.
Methods: A retrospective review of 73 patients who underwent resection of MPAs localized on SPECT-CT at a quaternary institution from 2017 to 2024 was performed. Descriptive statistics were used to analyze demographics, symptoms, lab values, imaging findings, operative details, and postoperative (post-op) courses. The Student's t-test was used to analyze the difference between the parathyroid hormone (PTH) and calcium (CA) levels before and after surgery.
Results: The majority were female with ages ranging 17-84. All but two patients (97%) were symptomatic preoperatively (pre-op) with almost half experiencing fatigue, neurocognitive symptoms, or bone and muscle pain, and about a third had nephrolithiasis. Almost all had prior operations, and a quarter had multiple prior surgeries. All had positive SPECT-CT localization pre-op with 60% in the left infra-innominate thymus, 28% in the right infra-innominate thymus, 8% in the aortopulmonary (PA) window, 3% in the right supra-innominate thymus, and 1% in the tracheoesophageal (TE) groove. All infra-innominate adenomas were approached supine with three robotic trocars. The six PA window and one TE groove adenoma were approached in the lateral decubitus position robotically or via an axillary thoracotomy. Partial sternotomy was used for both supra-innominate adenomas. There were six patients that did not have parathyroid tissue identified on pathology. However, despite this, all patients who underwent tissue resection had normalization of post-op PTH and CA. The average pre-op PTH was 195 and was reduced to 30 post-op (p<0.01). Similarly, average pre-op CA was 11 and dropped to 9 post-op (p<0.01). One case was aborted secondary to PA hematoma, four patients had self-limiting post-op complications, and 1 patient had vocal cord immobility requiring injection. There were no mortalities (Table).
Conclusions: SPECT-CT was able to localize 100% of the mediastinal parathyroid adenomas preoperatively, which guided the operative approach with 100% success in normalizing PTH and CA after adenoma resection.
THORACIC:
Chest Wall, Pleural and Mediastinal Disease
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