DOI QR코드

DOI QR Code

Clinical Study on Safety and Efficacy of Microwave Ablation for Primary Hyperparathyroidism

  • Ying Wei (Department of Interventional Ultrasound, China-Japan Friendship Hospital) ;
  • Lili Peng (Department of Interventional Ultrasound, China-Japan Friendship Hospital) ;
  • Yan Li (Department of Interventional Ultrasound, China-Japan Friendship Hospital) ;
  • Zhen-long Zhao (Department of Interventional Ultrasound, China-Japan Friendship Hospital) ;
  • Ming-an Yu (Department of Interventional Ultrasound, China-Japan Friendship Hospital)
  • Received : 2019.08.11
  • Accepted : 2020.01.07
  • Published : 2020.05.01

Abstract

Objective: To evaluate the safety, feasibility, and efficacy of microwave ablation (MWA) for the treatment of primary hyperparathyroidism (PHPT). Materials and Methods: This study enrolled 67 PHPT patients (22 men, 45 women; mean age, 56.0 ± 16.3 years; range, 18-83 years) from January 2015 to December 2018. The laboratory data, including the serum intact parathyroid hormone (iPTH), calcium, phosphorus, and alkaline phosphatase (ALP) levels, were evaluated before MWA and again 2 hours, 1 day, 7 days, 1 month, 3 months, 6 months, 12 months, 18 months, and 24 months after. Results: Complete ablation was achieved with all 72 hyperplastic parathyroid glands found on the 67 patients enrolled, 64 of whom were treated in one session and 3 were treated over two sessions. The technical success rate was 100%. The median follow-up time was 13.6 months (range, 10.0-31.1 months). The clinical success rate was 89.4%. The volume reduction rate was 79.4% at 6 months. Compared to pre-MWA, the serum iPTH, calcium, phosphorus, and ALP levels had significantly improved 6 months post-MWA (iPTH, 157.3 pg/mL vs. 39.2 pg/mL; calcium, 2.75 ± 0.25 mmol/L vs. 2.34 ± 0.15 mmol/L; phosphorus, 0.86 ± 0.20 mmol/L vs. 1.12 ± 0.22 mmol/L; ALP, 79 U/L vs. 54 U/L, respectively; all, p < 0.01). Hoarseness was a major complication in 4 patients (6.0%), but it improved spontaneously within 2-3 months. Conclusion: MWA is safe, feasible, and effective for the treatment of PHPT.

Keywords

Acknowledgement

This work was funded by Beijing Municipal Science & Technology Commission (Z181100001718135) and Beijing University of Chemical Technology-China-Japan Friendship Hospital Biomedical Transformation Joint Fund Project (PYBZ1804).

References

  1. Fraser WD. Hyperparathyroidism. Lancet 2009;374:145-158 
  2. Applewhite MK, Schneider DF. Mild primary hyperparathyroidism: a literature review. Oncologist 2014;19:919-929 
  3. Zhao L, Liu JM, He XY, Zhao HY, Sun LH, Tao B, et al. The changing clinical patterns of primary hyperparathyroidism in Chinese patients: data from 2000 to 2010 in a single clinical center. J Clin Endocrinol Metab 2013;98:721-728 
  4. Wilhelm SM, Wang TS, Ruan DT, Lee JA, Asa SL, Duh QY, et al. The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg 2016;151:959-968 
  5. Schneider DF, Mazeh H, Chen H, Sippel RS. Predictors of recurrence in primary hyperparathyroidism: an analysis of 1386 cases. Ann Surg 2014;259:563-568 
  6. Simental A, Ferris RL. Reoperative parathyroidectomy. Otolaryngol Clin North Am 2008;41:1269-1274 
  7. Yen TW, Wang TS, Doffek KM, Krzywda EA, Wilson SD. Reoperative parathyroidectomy: an algorithm for imaging and monitoring of intraoperative parathyroid hormone levels that results in a successful focused approach. Surgery 2008;144:611-619; discussion 619-621 
  8. Hamdy NA. Parathyroid gland: is parathyroidectomy safe and beneficial in the elderly? Nat Rev Endocrinol 2009;5:422-423 
  9. Richards ML, Thompson GB, Farley DR, Grant CS. Reoperative parathyroidectomy in 228 patients during the era of minimal-access surgery and intraoperative parathyroid hormone monitoring. Am J Surg 2008;196:937-942; discussion 942-943 
  10. Henry JF. Reoperation for primary hyperparathyroidism: tips and tricks. Langenbecks Arch Surg 2010;395:103-109 
  11. Marcocci C, Bollerslev J, Khan AA, Shoback DM. Medical management of primary hyperparathyroidism: proceedings of the fourth international workshop on the management of asymptomatic primary hyperparathyroidism. J Clin Endocrinol Metab 2014;99:3607-3618 
  12. Stratigis S, Stylianou K, Mamalaki E, Perakis K, Vardaki E, Tzenakis N, et al. Percutaneous ethanol injection therapy: a surgery-sparing treatment for primary hyperparathyroidism. Clin Endocrinol (Oxf) 2008;69:542-548 
  13. 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 
  14. 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 
  15. 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 
  16. 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 
  17. 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 
  18. 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 
  19. 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 
  20. 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 
  21. Zhuo Li, Peng L, Zhang Y, Xu Z, Zou G, 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 
  22. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al.; National Osteoporosis Foundation. Clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int 2014;25:2359-2381 
  23. Monchik JM, Donatini G, Iannuccilli J, Dupuy DE. Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma. Ann Surg 2006;244:296-304 
  24. Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the fourth international workshop. J Clin Endocrinol Metab 2014;99:3561-3569 
  25. Mauri G, Pacella CM, Papini E, Solbiati L, Goldberg SN, Ahmed M, et al. Image-guided thyroid ablation: proposal for standardization of terminology and reporting criteria. Thyroid 2019;29:611-618 
  26. Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, et al.; International Working Group on Image-guided Tumor Ablation, Interventional Oncology Sans Frontieres Expert Panel, Technology Assessment Committee of the Society of Interventional Radiology, Standard of Practice Committee of the Cardiovascular and Interventional Radiological Society of Europe. Image-guided tumor ablation: standardization of terminology and reporting criteria-A 10-year update. Radiology 2014;273:241-260 
  27. Kim J, Baek JH, Lim HK, Ahn HS, Baek SM, Choi YJ, et al.; Guideline Committee for the Korean Society of Thyroid Radiology (KSThR) and Korean Society of Radiology. 2017 thyroid radiofrequency ablation guideline: Korean Society of Thyroid Radiology. Korean J Radiol 2018;19:632-655 
  28. Miller BS, Dimick J, Wainess R, Burney RE. Age- and sex-related incidence of surgically treated primary hyperparathyroidism. World J Surg 2008;32:795-799 
  29. Huang DK, Chou FF, Chi SY, Chan YC, Huang SC. Surgical management of primary hyperparathyroidism: a single-center experience. Asian J Surg 2018;41:377-383 
  30. Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 1999;341:1249-1255 
  31. Rubin MR, Bilezikian JP, McMahon DJ, Jacobs T, Shane E, Siris E, et al. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab 2008;93:3462-3470 
  32. Cesareo R, Di Stasio E, Vescini F, Campagna G, Cianni R, Pasqualini V, et al. Effects of alendronate and vitamin D in patients with normocalcemic primary hyperparathyroidism. Osteoporos Int 2015;26:1295-1302 
  33. Nawrot I, Chudzin'ski W, Cia˛c' ka T, Barczyn'ski M, Szmidt J. Reoperations for persistent or recurrent primary hyperparathyroidism: results of a retrospective cohort study at a tertiary referral center. Med Sci Monit 2014;20:1604-1612 
  34. Wade TJ, Yen TW, Amin AL, Wang TS. Surgical management of normocalcemic primary hyperparathyroidism. World J Surg 2012;36:761-766 
  35. 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 
  36. Udelsman R, Lin Z, Donovan P. The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism. Ann Surg 2011;253:585-591 
  37. 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 
  38. Yu MA, Yao L, Zhang L, Peng L, Zhuo L, Zhang Y, et al. Safety and efficiency of microwave ablation for recurrent and persistent secondary hyperparathyroidism after parathyroidectomy: a retrospective pilot study. Int J Hyperthermia 2016;32:180-186 
  39. 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 
  40. Zini M, Attanasio R, Cesareo R, Emmolo I, Frasoldati A, Gianotti L, et al. AME position statement: primary hyperparathyroidism in clinical practice. J Endocrinol Invest 2012;35(7 Suppl):2-21