[Radio-guided parathyroidectomy: successful intraoperative parathyroid localization diagnosis with 99mTc-sestamibi in primary and recurrent hyperparathyroidism].
BACKGROUND
In addition to ultrasonography, CT scan, MRI and venous sampling, 99mTc-MIBI scintigraphy has gained increasing acceptance in preoperative localization of abnormal parathyroid tissue. The sensitivity of this radionuclide method is 87% in primary (p), 58% in secondary (s), and 75% in recurrent hyperparathyroidism (HPT). This study evaluated the use of intraoperative nuclear mapping in patients with HPT.


METHODS
Retrospective analysis was performed in 24 patients with HPT (18 p, 4 s, 2 recurrent) undergoing a technetium-sestamibi-guided neck exploration during an 18-months period. Abnormal parathyroid tissue was localized using an intraoperative gamma probe detector 2 h after application of 700 MBq 99mTc-sestamibi and verified by pathology.


RESULTS
Intraoperative nuclear mapping identified 15 of 18 adenomas in patients with pHPT. The target-to-background ratio was 1.3 to 4.1 in these patients compared to 1.0 to 1.2 in undetected adenomas. In 67% of these patients we performed a minimally invasive open parathyroidectomy. In two cases of recurrent HPT the scan-guided detection of ectopic parathyroid tissue was efficient. In contrast, the method was less helpful in four patients with multiglandular disease.


CONCLUSIONS
The intraoperative use of a gamma probe detector is highly effective in identifying parathyroid adenomas in pHPT and recurrent HPT and supports minimally invasive techniques.
Geissler
B
B
Klinik für Allgemein- und Viszeralchirurgie, Klinikum Augsburg.
Gröber
S
S
Zügel
N
N
Lindemann
F
F
D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery*; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012008:Recurrence; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi