Microwave Ablation for Patients Who Refuse Surgery or a Bad Risk for Primary Hyperparathyroidism
Parathyroid adenoma on US imaging
Parathyroid scan with delayed image showing the adenoma
Journal of Vascular and Interventional Radiology
Volume 27, Issue 6, June 2016, Pages 867–875
US-Guided Percutaneous Microwave Ablation for Primary Hyperparathyroidism with Parathyroid Nodules: Feasibility and Safety Study
Can Liu et al
To test the feasibility, safety, and efficacy of microwave (MW) ablation for primary hyperparathyroidism (pHPT) in patients who are unsuited or unwilling to undergo surgery.
15 patients were followed up for more than 1 year, with an average duration of 32.8 months ± 17.9. Eleven patients underwent successful ablation in a single session, and two patients with bilateral disease and two patients with residual disease were treated with two sessions each. The rate of complete nodule disappearance was 17.6%. Nodule volume and serum parathyroid hormone (PTH) and calcium levels were significantly lower at the last follow-up than before treatment (volume, 0.39 cm3 ± 0.69 vs 2.62 cm3 ± 3.32; PTH, 54.5 pg/mL ± 24.1 vs 592.5 pg/mL ± 579.1; and calcium, 2.32 mmol/L ± 0.12 vs 2.93 mmol/L ± 0.47; P < .01). Treatment was well tolerated. Minor complications included transient voice change in one patient.
MW ablation is a safe and effective technique for the treatment of pHPT. It is a good alternative for patients who do not meet surgery criteria or decline surgery.
Comment: Similar to other ablation systems there is still no replacing surgery as it cures the patient while ablations are only a temporizing in difficult cases refusing surgery.The disease will recur.
Richard Guttler MD,FACE,ECNU
Drawing of MWA system