Potential role for intraoperative gamma probe identification of normal parathyroid glands.
BACKGROUND
Patients undergoing central neck surgery are at risk for hypoparathyroidism. We hypothesized that gamma probe identification of sestamibi-labeled parathyroid glands might help maximize parathyroid preservation.


METHODS
Records of 351 patients who underwent central neck surgery were reviewed. A subgroup of patients underwent sestamibi injection followed by gamma probe-directed parathyroid gland identification.


RESULTS
Operation was performed for malignancy in 73% of patients and represented a reoperation in 34%. Persistent hypoparathyroidism was more common in patients who underwent reoperation versus a primary operation (6.8% versus 1.7%; P = 0.02). Thirteen patients underwent gamma probe-directed identification of sestamibi-labeled parathyroid glands; in 6 of these patients, sestamibi-labeled parathyroid glands were salvaged from the resected specimens and autografted. None of these 13 patients developed persistent hypoparathyroidism.


CONCLUSIONS
Patients undergoing reoperative central neck surgery are at increased risk for postoperative hypoparathyroidism. Gamma probe-directed salvage of sestamibi-labeled parathyroid glands may help maximize parathyroid preservation, especially in complex or reoperative central neck surgery.
Pederson
Lee C
LC
Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Shapiro
Suzanne E
SE
Fritsche
Herbert A
HA
Delpassand
Ebrahim S
ES
Gagel
Robert F
RF
Sherman
Steven I
SI
Vassilopoulou-Sellin
Rena
R
Evans
Douglas B
DB
Lee
Jeffrey E
JE
D015902:Gamma Cameras; D006801:Humans; D006996:Hypocalcemia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D007011:Hypoparathyroidism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D007432:Intraoperative Period; D008197:Lymph Node Excision / Q000009:adverse effects; D016343:Monitoring, Intraoperative; D009333:Neck / Q000601:surgery*; D010280:Parathyroid Glands / Q000000981:diagnostic imaging*; D010281:Parathyroid Hormone / Q000097:blood; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012086:Reoperation; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D013965:Thyroidectomy / Q000009:adverse effects
D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi