Methods of medical visualization and thermal ablation as a new approach to treatment of hyperparathyroidism

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Abstract

The pathologies of parathyroid glands are widespread among endocrine system diseases, excluding diabetes and thyroid pathology. There are only two methods that are used to treat hyperparathyroidisms, such as surgery and conservative therapy. However, transracial thermal destruction methods (ablation) have recently appeared in clinical practice. The methods have good precision and connect with physical phenomena, such as interaction laser, radiofrequency, microwave, and HIFU irradiation with bio substance. The review is dedicated to critically analyze the modern methods for local thermal destruction of the hyper-functioning parathyroid glands. The review includes data from randomized clinical trials from 2012 to 2021. The studies were from Google Scholar and Pubmed with a total number of 1,938 patients (laser ablation ― 216 patients, radiofrequency ablation ― 225, microwave ablation ― 1467, high-density ultrasound ablation ― 30 patients). Recommendations methods of thermal destruction application were obtained during the review. Furthermore, we have designed some algorithms for hyperparathyroidism treatment. Moreover, thermal destruction methods were observed. There are four modern methods of thermal destruction which have been analyzed like alternatives to surgery. Each of them has advantages and disadvantages, its profile of safety and effectiveness. After processing information from a proven database, the most popular among specialists is methods of microwave ablation. However, laser ablation is more effective than other ways.

About the authors

Pavel O. Rumiantsev

International Medical Center “SOGAZ”

Email: pavelrum@gmail.com
ORCID iD: 0000-0002-7721-634X
SPIN-code: 7085-7976

MD, Dr. Sci. (Med.)

Russian Federation, 8 Malaya Konyushennaya str., Saint Petersburg, 191186

Aleksandr A. Bubnov

Endocrinology Research Centre; National Research Nuclear University MEPhI (Moscow Engineering Physics Institute)

Email: bubnov96@mail.ru
ORCID iD: 0000-0002-5877-6982
SPIN-code: 9380-1293

graduate student

Russian Federation, Moscow; Moscow

Mikhail V. Degtyarev

Endocrinology Research Centre

Email: germed@mail.ru
ORCID iD: 0000-0001-5652-2607

MD, radiologist

Russian Federation, Moscow

Konstantin Y. Slushchuk

Endocrinology Research Centre

Email: slashuk911@gmail.com
ORCID iD: 0000-0002-3220-2438

MD, endocrinologist, researcher

Russian Federation, Moscow

Svetlana M. Zakharova

Endocrinology Research Centre

Email: smzakharova@mail.ru
ORCID iD: 0000-0001-6059-2827
SPIN-code: 9441-4035

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Dmitriy Y. Agibalov

Endocrinology Research Centre

Email: agibalovd@bk.ru
ORCID iD: 0000-0003-2995-7140

doctor

Russian Federation, Moscow

Viktor Y. Timoshenko

National Research Nuclear University MEPhI (Moscow Engineering Physics Institute); Lomonosov Moscow State University

Author for correspondence.
Email: vtimoshe@gmail.com
ORCID iD: 0000-0003-3234-1427
SPIN-code: 7536-2368

Dr. Sci. (Phys-Math), Professor

Russian Federation, Moscow; Moscow

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Supplementary files

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2. Fig. 2. Ultrasound imaging of hyperfunctioning parathyroid glands in hyperparathyroidism: a - primary hyperparathyroidism; b - secondary hyperparathyroidism.

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3. Fig. 3. Two-isotope scintigraphy: a - scintigraphy with 99mTc-MIBI; b - scintigraphy with 99mTc-TcO4.

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4. Fig. 4.

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5. Fig. 6. Images obtained with multichannel gamma probes Sentinella-102 (a – c) and CrystalCam (d).

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6. Fig. 7. Laser ablation in primary hyperparathyroidism: a - parathyroid adenoma; b - the presence of two laser fibers and the area of the parathyroid gland after ablation.

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7. Fig. 8.

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8. Fig. 1. Dynamics of publications on the use of alternative methods for periothyroid gland destruction.

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9. Fig. 5. Hyperparathyroidism diagnosis algorithm.

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10. Fig. 8. Hyperparathyroidism treatment algorithm.

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11. Fig. 9. Summary of the advantages (green) and disadvantages (red) of the methods for thermal destruction of the parathyroid glands.

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Copyright (c) 2021 Rumiantsev P.O., Bubnov A.A., Degtyarev M.V., Slushchuk K.Y., Zakharova S.M., Agibalov D.Y., Timoshenko V.Y.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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