A patient with primary hyperparathyroidism was examined with positron emission tomography using [18F]-2-fluorodeoxyglucose. The radioactive tracer accumulated in a cervical mass that proved to be a parathyroid adenoma resulting in the correct preoperative localization of the parathyroid tumor.

Adenoma↗

PubMedDate not supplied

Regional body FDG-PET in postoperative recurrent hyperparathyroidism.

PURPOSE: The use of preoperative imaging studies in patients with persistent or recurrent hyperparathyroidism after initial operation is generally accepted to improve the success rate and minimize the morbidity from reoperative surgery. The purpose of this study was to define the performance of FDG-PET for the localization of hyperfunctioning parathyroid tissue prior to reoperation. METHOD: Twenty patients with biochemical evidence of recurrent or persistent hyperparathyroidism following previous neck surgery were investigated. Regional body PET imaging of the neck and upper chest (axial field of view 27.5 cm) was acquired 45 min after 5-10 mCi FDG was given intravenously. RESULTS: Subsequent surgery revealed solitary parathyroid adenomas in 14 patients, seven hyperplastic glands in 2 patients, and parathyroid carcinoma in 1 patients. FDG-PET correctly identified 79% (11/14) of the parathyroid adenomas, 29% (2/7) of the hyperplastic glands, and the parathyroid carcinoma. FDG-PET was negative in 79% (30/38) of the surgically identified normal parathyroid glands. Eight false-positive findings led to a positive predictive value of 64%. CONCLUSION: These preliminary data suggest that regional body FDG-PET is a promising procedure in the evaluation of patients with persistent or recurrent postoperative hyperparathyroidism.

Adenoma↗

PubMedDate not supplied

Use of thallium-technetium parathyroid scans.

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Adolescent↗

PubMedDate not supplied

Factors influencing local recurrence of cancer after partial mastectomy.

From 1957 to 1975, 291 patients underwent partial mastectomy for carcinoma of the breast. In a follow-up period of 6 to 25 years, 32 patients had local recurrences. These 32 were matched with 32 patients without local recurrence but who had had the same treatment during the same periods of time for the same clinical stage of disease. Comparisons were made for age of the patient, family history, size of tumor, proximity of tumor to line of resection, involvement of lymph nodes, and prophylactic radiation. The average age of the patients with recurrence was 7 years less than those without, and the incidence of nodal involvement was three times as high in those with local recurrence as in those without. These were the only factors that showed any significant difference between the two groups. When axillary dissection is done in patients treated by partial mastectomy, valuable information is obtained about the likelihood of local recurrence.

Age Factors↗

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Parathyroid carcinoma: 50-year experience at The Cleveland Clinic Foundation.

BACKGROUND: Parathyroid carcinoma is rare, with a reported prevalence of 0.6% to 4.0% in patients presumed to have primary hyperparathyroidism. This study examines the long-term results of surgical therapy and combination chemotherapy. PATIENTS: From 1938 to 1988, 1260 operations for primary hyperparathyroidism were performed; only six patients (0.47%) were subsequently found to have parathyroid carcinoma. A seventh patient was referred to our institution after the diagnosis of parathyroid carcinoma had been made. RESULTS: All patients had excessive hypercalcemia (serum calcium concentration > 12.0 mg/dL) with a range of 12.3 to 18.3 mg/dL. Locally recurrent tumors causing recurrent hypercalcemia were managed by repeated neck exploration and tumor resection. Six of the seven patients (85%) survived 5 years, while four patients (57%) survived 10 years. CONCLUSIONS: Diagnosis of parathyroid carcinoma rests upon postoperative surveillance of patients who have undergone previous neck exploration and resection of apparently benign adenomas. Long-term survival is possible with repeated resection of locally recurrent tumors.

Adult↗

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Breast-conserving surgery: how much is enough?

Breast-conserving operations for the treatment of small, apparently localized invasive breast cancer are now accepted by most surgeons. Still controversial are (1) the size of the primary tumor selected for breast conservation treatment, (2) how much breast tissue must be removed to provide an "adequate" margin to achieve local control, and (3) whether the entire breast needs to be treated by radiation therapy in all patients after adequate partial mastectomy. The results of breast-conserving operations at the Cleveland Clinic are presented and the case for selected, individualized therapy utilizing partial mastectomy without radiation therapy for selected patients with small invasive cancers is made.

Breast Neoplasms↗

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Thyroid lesions in patients with hyperparathyroidism.

Twenty of ninety patients with hyperparathyroidism had associated pathology of the thyroid gland. Three carcinomas of the thyroid were found incidentally at the time of surgery for hyperparathyroidism. The association of thyroid lesions and hyperparathyroidism was frequently reported and explained previously on the basis of hypercalcemia acting as a goitrogen. Current evidence, however, suggests radiation as a strong probable factor in the production of this association. Attention should be given to the thyroid gland and of dominant nodules inspected. Concomitant management of those nodules according to the degree of suspicion they arouse, should be undertaken at the time of neck exploration for hyperparathyroidism.

Adenoma↗