[Radioguided surgery for primary hyperparathyroidism: 100 cases].
One hundred patients with primary hyperparathyroidism underwent radioguided surgery within 90 to 180 minutes following IV injection of a diagnostic dose of MIBI and after parathyroid scanning with planar and oblique views. Exclusion criteria were thyroid pathology requiring surgery and suspicion of multiple endocrine neoplasia. A>20% step-up between the background noise and tissue uptake was the diagnostic threshold for parathyroid hyperfunctionning tissue, and this was observed in only 15% of cases overall all cured, but two. This method of detection is technically demanding and various angles of application of the probe can result in significant discrepancies of recorded uptake for the same spot. Our results demonstrate a physiological step-up between the ipsilateral unaffected upper and lower quadrants of the neck (range: - 34% to - 5%), seemingly because of the proximity of supra-aortic vessels (upper neck-upper mediastinal gradient: - 57% to - 21%). Therefore, significant ratios are meaningful only between either the symmetrical left and right controlateral quadrants, 8% of pre-operative scannings were non-contributory, and probe detection was contributory in 3/8 cases only. Benefit of the technique is limited in routine, but it can be helpful in redo cases if the offending gland is not located in close surroundings of tissues physiologically taking up the radio pharmaceutical (salivary glands, great vessels and heart).
Clinique chirurgicale Adulte est, service de Chirurgie Générale et Endocrinologie, Hôpital Huriez, 1 rue Michel Polonovski, 59037 LILLE Cedex, France.
O
O
Fouquet
P E
PE
Mortier
J
J
Lokey
A
A
Mondragon-Sanchez
F
F
Salazar Navarro
F
F
Pattou
B
B
Carnaille
D
D
Huglo
C
C
Proye
D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods; D011877:Radionuclide Imaging; D016634:Radiosurgery; D017256:Technetium Tc 99m Sestamibi; D013965:Thyroidectomy
D017256:Technetium Tc 99m Sestamibi