Ultrasound-guided thermal ablation for hyperparathyroidism: current status and prospects

Figures & data

Figure 1. Schematic diagram of ultrasound-guided percutaneous thermal ablation of HPT. 1. Linear array probe used for guiding and positioning; 2. ablation needle; 3. skin and subcutaneous soft tissue; 4. fascia tissue; 5. anterior cervical muscles; 6. thyroid gland; 7. trachea; 8. carotid artery; 9. hyperplastic parathyroid gland; 10. internal jugular vein.

Table 1. Baseline characteristics of patients undergoing laser ablation for hyperparathyroidism.

Reference	Patient	Sex (M/F)	Age range	LA Power(J)	Follow-up (Month)	Pre-PTH/Post-PTH (Normal value)	Pre-Ca/Post-Ca (Normal value)	Complication
Massimiliano et al. [52]	6	0/6	48-70	1000-4200	24	16.8 ± 7.7/15.0 ± 4.75 (0.9-8.2 pmol/L)	2.8 ± 0.4/2.6 ± 0.2 (2.12-2.60 mmol/L)	33.33%
Appelbaum et al. [53]	12	3/9	43-81	1600-7200	24	416 ± 230/60.5 ± 25 (20-80 pg / mL)	11.4 ± 1.2/9.3 ± 0.7 (8.6–10.3 mg / dl)	8.33%
Adda et al. [54]	3	0/3	70-75	600-1200	36	205.7 ± 71.5/175.0 ± 118.4 (10-70pg/mL)	11.9 ± 0.9/10.4 ± 0.6 (8.5-10.6 mg/mL)	33.33%

M/F replaces male/female; pre PTH/post PTH, and pre-Ca/post-Ca represents PTH and serum Ca levels before and after LA respectively; Complication, Transient vocal cord paralysis.

Table 2. Baseline characteristics of patients undergoing radiofrequency ablation for hyperparathyroidism.

Study, year	Patient	Sex (M/F)	Primary/ Secondary	Average age	Follow up (Month)	Cure rate	Complication
Li X, et al. 2021	25	3/-22	25/-	53.9 ± 10.9	12	84%	20%
Peng C, et al. 2017	34	3/-31	-/34	50.8 ± 8.3	12	–	88%
Wei Y, et al. 2021	27	–	27/ -	58.9 ± 15.6	12	88.90%	3.70%
Zeng Z, et al. 2020	56	22/-34	-/56	53.5 ± 10.1/45.5 ± 12.9	–	–	100.00%
Ha EJ, et al. 2020	19	5/-14	11/ −8	64.8 ± 15.0/61.6 ± 17.3	12	63.60%	15.79%
Sormaz IC, et al. 2017	5	2/-3	5/ -	51.4 ± 24.5	6	60%	40%

Primary/Secondary, PTPH/STPH; Complication, Slight pain, transient elevation of blood calcium, choking and coughing in drinking water, elevated body temperature and sound changes.

Figure 2. Sonogram of parathyroid adenoma before and after MWA. A 56-year-old woman was diagnosed with a parathyroid adenoma by ultrasound-guided biopsy before ablation. (a) Sonogram of parathyroid adenoma before MWA: the adenoma was hypoechoic, with a regular shape and clear boundary. Color Doppler flow imaging reveals a slightly rich-colored blood flow in the interior and edge; (b) Before MWA, the adenoma showed uniform and high enhancement in contrast-enhanced ultrasound (CEUS); (c) During ablation. (d) After ablation, there was almost no enhancement in CEUS. (e) One month after MWA, no obvious blood flow was found in the tumor.

Figure 3. Schematic diagram of HIFU in the treatment of HPT.

Andrioli M, Riganti F, Pacella CM, et al. Long-term effectiveness of ultrasound-guided laser ablation of hyperfunctioning parathyroid adenomas: present and future perspectives. AJR Am J Roentgenol. 2012;199(5):1164–1168.

 PubMed Web of Science ®Google Scholar

Appelbaum L, Goldberg SN, Ierace T, et al. US-guided laser treatment of parathyroid adenomas. Int J Hyperthermia. 2020;37(1):366–372.

 PubMed Web of Science ®Google Scholar

Adda G, Scillitani A, Epaminonda P, et al. Ultrasound-guided laser thermal ablation for parathyroid adenomas: analysis of three cases with a three-year follow-up. Horm Res. 2006;65(5):231–234.

 PubMedGoogle Scholar