title: The use of radioiodinated toluidine blue for preoperative localization of parathyroid pathology.
abstract: The efficiency of preoperative radioactive toluidine blue (RTB) scintigraphy for the localization of parathyroid pathology was evaluated prospectively in 69 patients (age range, 15 to 81 years; mean, 56 years) with primary hyperparathyroidism. Four patients have previously undergone negative exploratory surgery. Patients underwent preoperative dual radionuclide parathyroid-RTB/technetium 99m (Tc 99m)-thyroid scintigraphies with a computer-interfaced gamma-camera with a pinhole collimator. Computer-acquired scintigraphic data were analyzed for parathyroid localizations by an RTB-parathyroid/thyroid superposition technique. At surgery, parathyroid adenomas were found in 64 patients (single adenomas in 60 patients; two adenomas in four patients), nine of these adenomas were mediastinal. Four patients had parathyroid hyperplasia. One patient had no parathyroid pathology (negative exploratory surgery). Correlation between the surgical-pathologic findings and the scintigraphic RTB localization studies disclosed a sensitivity of 87%, with a specificity of 94%, and an overall accuracy of 92%. The routine use of preoperative scintigraphic parathyroid-RTB/Tc 99m-thyroid localization has proved to be highly effective, enabling detection of small hyperfunctioning parathyroid glands in normal and ectopic locations in a wide range of weights. In this series a success rate of 98% was achieved on initial and reexploratory surgery for primary hyperparathyroidism.
authors.affiliation: Department of Surgery, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Czerniak
authors.forename: S T
authors.initials: ST
authors.lastname: Zwas
authors.forename: O
authors.initials: O
authors.lastname: Shustik
authors.forename: I
authors.initials: I
authors.lastname: Avigad
authors.forename: A
authors.initials: A
authors.lastname: Ayalon
authors.forename: E
authors.initials: E
authors.lastname: Dolev
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006965:Hyperplasia; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000473:pathology; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016105:Parathyroidectomy; D011446:Prospective Studies; D011877:Radionuclide Imaging; D013667:Technetium; D014048:Tolonium Chloride
chemical_list: D007457:Iodine Radioisotopes; D014048:Tolonium Chloride; D013667:Technetium