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Surgery May 2024Preoperative imaging before parathyroidectomy can localize adenomas and reduce unnecessary bilateral neck explorations. We hypothesized that (1) the utility of...
BACKGROUND
Preoperative imaging before parathyroidectomy can localize adenomas and reduce unnecessary bilateral neck explorations. We hypothesized that (1) the utility of preoperative imaging varies substantially depending on the preoperative probability of having adenoma(s) and (2) that a selective imaging approach based on this probability could avoid unnecessary patient costs and radiation.
METHODS
We analyzed 3,577 patients who underwent parathyroidectomy for primary hyperparathyroidism from 2001 to 2022. The predicted probability of patients having single or double adenoma versus hyperplasia was estimated using logistic regression. We then estimated the relationship between the predicted probability of single/double adenoma and the likelihood that sestamibi or 4-dimensional computed tomography was helpful for operative planning. Current Medicare costs and published data on radiation dosing were used to calculate costs and radiation exposure from non-helpful imaging.
RESULTS
The mean age was 62 ± 13 years; 78% were women. Adenomas were associated with higher mean calcium (11.2 ± 0.74 mg/dL) and parathyroid hormone levels (140.6 ± 94 pg/mL) than hyperplasia (9.8 ± 0.52 mg/dL and 81.4 ± 66 pg/mL). The probability that imaging helped with operative planning increased from 12% to 65%, as the predicted probability of adenoma increased from 30% to 90%. For every 10,000 patients, a selective approach to imaging that considered the preoperative probability of having adenomas could save patients up to $3.4 million and >239,000 millisieverts of radiation.
CONCLUSION
Rather than imaging all patients with primary hyperparathyroidism, a selective strategy that considers the probability of having adenomas could reduce costs and avoid excess radiation exposure.
Topics: United States; Humans; Female; Aged; Middle Aged; Male; Parathyroidectomy; Hyperparathyroidism, Primary; Parathyroid Neoplasms; Technetium Tc 99m Sestamibi; Hyperplasia; Medicare; Radiopharmaceuticals; Parathyroid Hormone; Adenoma
PubMed: 38433078
DOI: 10.1016/j.surg.2024.01.032 -
Chest Mar 1977Among 28 patients with bronchial adenomas, 24 adenomas (86%) were of the carcinoid type. The 28 bronchial adenomas provided an incidence of 0.6% of all primary lung...
Among 28 patients with bronchial adenomas, 24 adenomas (86%) were of the carcinoid type. The 28 bronchial adenomas provided an incidence of 0.6% of all primary lung tumors seen in our institutions. There was a slightly greater preponderance of female patients and a greater incidence of the lision occurring in the right bronchopulmonary tree than the left. Symptoms of bronchial adenoma may exist for many years before the condition is diagnosed, and prolonged survival is recorded, even in the absence of surgical treatment. Although pneumonectomy was performed in several patients, lobectomy, bronchoplastic procedures, or sleeve resection of the affected area are generally recommended.
Topics: Adenoma; Adolescent; Adult; Age Factors; Aged; Bronchi; Bronchial Neoplasms; Child; Female; Humans; Male; Middle Aged; Neoplasm Metastasis; Pneumonectomy; Sex Factors
PubMed: 837751
DOI: 10.1378/chest.71.3.376 -
PloS One 2018Telomere length has been associated with risk of several cancers. However, studies of the relationship between telomere length and colorectal cancer risk have been...
Telomere length has been associated with risk of several cancers. However, studies of the relationship between telomere length and colorectal cancer risk have been inconsistent. This study examined the relationship between telomere length in normal colon tissue and the prevalence of colorectal adenoma, a precursor to colorectal cancer. This nested case-control study consisted of 85 patients aged 40 to 65 undergoing a screening colonoscopy: 40 cases with adenoma(s) detected at colonoscopy and 45 controls with normal colonoscopy. During the colonoscopy, two pinch biopsies of healthy, normal appearing mucosa were obtained from the descending colon. Relative telomere length (rTL) was quantified in DNA extracted from colon mucosa using quantitative real-time PCR. Logistic regression was used to assess the relationship between telomere length and adenoma prevalence and estimate odds ratios and 95% confidence intervals. rTL was significantly longer in colon tissue of individuals with adenomas compared to healthy individuals (p = 0.008). When rTL was categorized into quartiles according to the distribution of rTL among controls, individuals with the longest telomeres had increased odds of adenoma when compared to individuals with shortest telomeres (OR = 4.58, 95% CI: 1.19, 17.7). This study suggests that long telomeres in normal colon tissue are associated with increased colorectal cancer risk.
Topics: Adenoma; Adult; Biopsy; Carcinogenesis; Case-Control Studies; Colon; Colonoscopy; Colorectal Neoplasms; Female; Genetic Predisposition to Disease; Humans; Intestinal Mucosa; Male; Middle Aged; Prevalence; Real-Time Polymerase Chain Reaction; Risk Factors; Telomere
PubMed: 30332457
DOI: 10.1371/journal.pone.0205697 -
Best Practice & Research. Clinical... Oct 2009Thyrotropin-secreting pituitary adenomas (TSHomas) are a rare cause of hyperthyroidism and account for less than 2% of all pituitary adenomas. In the last years, the... (Review)
Review
Thyrotropin-secreting pituitary adenomas (TSHomas) are a rare cause of hyperthyroidism and account for less than 2% of all pituitary adenomas. In the last years, the diagnosis has been facilitated by the routine use of ultra-sensitive TSH immunometric assays. Failure to recognise the presence of a TSHoma may result in dramatic consequences, such as improper thyroid ablation that may cause the pituitary tumour volume to further expand. The diagnosis mainly rests on dynamic testing, such as T3 suppression tests and TRH, which are useful in differentiating TSHomas from the syndromes of thyroid hormone resistance. The first therapeutical approach to TSHomas is the pituitary neurosurgery. The medical treatment of TSHomas mainly rests on the administration of somatostatin analogues, such as octreotide and lanreotide, which are effective in reducing TSH secretion in more than 90% of patients with consequent normalisation of FT4 and FT3 levels and restoration of the euthyroid state.
Topics: Adenoma; Diagnosis, Differential; Diagnostic Techniques, Endocrine; Humans; Hyperpituitarism; Models, Biological; Pituitary Neoplasms; Thyrotropin
PubMed: 19945025
DOI: 10.1016/j.beem.2009.05.006 -
Endoscopy Apr 2023
Topics: Humans; Artificial Intelligence; Adenoma
PubMed: 36882088
DOI: 10.1055/a-2038-7078 -
The Journal of Clinical Endocrinology... Sep 2010GH-secreting pituitary adenomas are nearly always visible on conventional magnetic resonance (MR) imaging. However, management and outcome of acromegalic patients...
CONTEXT
GH-secreting pituitary adenomas are nearly always visible on conventional magnetic resonance (MR) imaging. However, management and outcome of acromegalic patients lacking imaging evidence of GH-secreting pituitary adenomas are undefined.
OBJECTIVE
The aim was to evaluate surgical exploration for MR-invisible GH-secreting pituitary adenomas.
DESIGN AND SETTING
We conducted a retrospective review at two tertiary care centers.
PATIENTS OR OTHER PARTICIPANTS
Consecutive acromegalic patients without imaging evidence of a pituitary adenoma on pre- and postcontrast, spin echo T1-weighted MR imaging and who lacked evidence of an ectopic (nonpituitary) source causing GH excess were included.
INTERVENTIONS
Surgical exploration with identification and resection of a pituitary adenoma was performed.
MAIN OUTCOME MEASURES
Laboratory values (GH, IGF-I), surgical findings, and clinical outcome were analyzed.
RESULTS
Six patients (three males, three females; 3% of all patients) with suspected GH-secreting adenomas did not demonstrate imaging evidence of pituitary adenoma on conventional MR imaging. Three patients underwent a postcontrast, volumetric interpolated breath-hold examination MR-imaging sequence (1.2-mm slice thickness), which revealed a 4-mm pituitary adenoma not seen on the spin echo T1-weighted MR imaging in one patient. A pituitary adenoma was identified and removed in all patients (mean diameter, 5.6 mm; range, 5 to 6.7 mm). Histological analysis confirmed that the lesions were GH-secreting adenomas. All patients achieved biochemical remission after surgical resection.
CONCLUSION
Acromegaly can be caused by GH-secreting pituitary adenomas that are not evident on conventional MR imaging. Adenomas in some of these patients become evident using volumetric interpolated breath-hold examination MR imaging. Surgical exploration of the pituitary gland in acromegalic patients with endocrine findings consistent with a GH-secreting adenoma but negative MR imaging can lead to identification and removal of an adenoma.
Topics: Acromegaly; Adenoma; Adult; Aged; Diagnosis, Differential; False Negative Reactions; Female; Growth Hormone-Secreting Pituitary Adenoma; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Radiography; Retrospective Studies; Tumor Burden
PubMed: 20610592
DOI: 10.1210/jc.2010-0570 -
Oral Surgery, Oral Medicine, and Oral... Dec 1983There is considerable confusion in the literature concerning the terms monomorphic adenoma, basal cell adenoma, and canalicular adenoma. This article traces the history...
There is considerable confusion in the literature concerning the terms monomorphic adenoma, basal cell adenoma, and canalicular adenoma. This article traces the history of these terms as applied to the pathology of salivary gland tumors and attempts to clarify their usage. It is recommended (1) that monomorphic adenoma be used, as it was originally intended, as a nosologic grouping for all benign epithelial salivary gland tumors that are not pleomorphic adenomas, (2) that basal cell adenoma be used to identify a specific entity that is one component of the monomorphic adenoma group and exhibits a number of histologic subtypes, and (3) that canalicular adenoma be used to describe another entity, distinct from basal cell adenomas but also belonging to the monomorphic adenoma group.
Topics: Adenoma; Diagnosis, Differential; Humans; Salivary Gland Neoplasms; Terminology as Topic
PubMed: 6581459
DOI: 10.1016/0030-4220(83)90078-6 -
Brain Pathology (Zurich, Switzerland) Jul 2012Pituitary adenomas are common neuroendocrine neoplasms arising from adenohypophysial cells. Recent progress in our understanding of pituitary tumorigenesis as well as... (Review)
Review
Pituitary adenomas are common neuroendocrine neoplasms arising from adenohypophysial cells. Recent progress in our understanding of pituitary tumorigenesis as well as pathways involved in molecular cytodifferentiation of the adenohypophysis has impacted on the classification of pituitary adenomas. The detailed comprehensive classification of pituitary adenomas is now well recognized to reflect specific clinical features and genetic changes that predict targeted treatments, as well as prognostic information for patients with pituitary adenomas. Therefore, the clinical responsibility of pathologists is not only limited to the distinction of pituitary adenomas from other sellar lesions, but also to provide a comprehensive subtype classification using appropriate ancillary tools. In this article, we highlight an approach to clinical diagnosis and pitfalls in the classification of these common neoplasms.
Topics: Adenoma; Humans; Pituitary Neoplasms
PubMed: 22697380
DOI: 10.1111/j.1750-3639.2012.00599.x -
The American Surgeon Nov 1980Villous adenomas of the upper gastrointestinal tract, although rare, are difficult to diagnose and treat because of their location, invasiveness, and association with...
Villous adenomas of the upper gastrointestinal tract, although rare, are difficult to diagnose and treat because of their location, invasiveness, and association with adenocarcinoma. Two patients with duodenal villous adenoma and upper abdominal pain as the presenting symptoms are described. Endoscopy is important for early diagnosis. The recommended treatment is simple excision with biopsy, or pancreaticoduodenectomy if adenocarcinoma is present.
Topics: Adenoma; Duodenal Neoplasms; Humans; Male; Middle Aged
PubMed: 7436142
DOI: No ID Found -
Annals of the Royal College of Surgeons... May 2015Primary hyperparathyroidism is a relatively common problem encountered by any endocrine surgical unit. Ectopic parathyroid adenomas have been known to be a common cause... (Review)
Review
Primary hyperparathyroidism is a relatively common problem encountered by any endocrine surgical unit. Ectopic parathyroid adenomas have been known to be a common cause of persistent hyperparathyroidism after surgery. A common site of the missed ectopic gland will be that in the mediastinum. However, with the increasing improvement in available imaging, it is likely that this can be diagnosed preoperatively. The surgical approach to the mediastinal parathyroid has also changed vastly over the last decade from maximally invasive to minimally invasive with minimal complications. We provide a review on the entity of mediastinal parathyroid adenomas and their surgical implications.
Topics: Adenoma; Humans; Mediastinal Neoplasms; Parathyroid Neoplasms
PubMed: 26263931
DOI: 10.1308/003588415X14181254789088