title: Usefulness of radio-guided surgery using technetium-99m methoxyisobutylisonitrile for primary and secondary hyperparathyroidism.
abstract: The efficacy of technetium-99m methoxyisobutylisonitrile (99mTc-MIBI)-guided surgery for detecting abnormal parathyroid glands in patients with secondary hyperparathyroidism (2-HPT) was evaluated and compared with the results from the same examination in patients with primary hyperparathyroidism (1-HPT). The results were also compared with those found by ultrasonography (US) and preoperative 99mTc-MIBI scintigraphy was also made. At operation 99mTc-MIBI accumulated in 64 nodules of 15 cases of 2-HPT, and all of 60 parathyroid swellings were detected (true-positives 60, sensitivity 100%, accuracy 94%). In the cases of 1-HPT, 99mTc-MIBI revealed 11 hot nodules in 10 cases, and the evaluation was true-positive 10, sensitivity 100%, and accuracy 91%. US and preoperative 99mTc-MIBI scintigraphy in patients with 2-HPT had a sensitivity of 75% and 67% and an accuracy of 70% and 66%, respectively. The usefulness of 99mTc-MIBI-guided surgery for detecting abnormal parathyroid tissue in 2-HPT patients was similar to that in 1-HPT patients but was superior to US and preoperative 99mTc-MIBI scintigraphy. Intraoperative 9mTc-MIBI for patients with 2-HPT is effective and makes the surgery easier, especially when the parathyroid glands are ectopic or when a few glands are markedly enlarged but the other glands are atrophied.
authors.affiliation: Department of Surgery, Jikei University School of Medicine, Tokyo, Japan. takeyama@jikei.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takeyama
authors.forename: Hisashi
authors.initials: H
authors.lastname: Shioya
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Mori
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Ogi
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Naohiko
authors.initials: N
authors.lastname: Kato
authors.forename: Satoki
authors.initials: S
authors.lastname: Kinoshita
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yoshida
authors.forename: Ken
authors.initials: K
authors.lastname: Uchida
authors.forename: Yoji
authors.initials: Y
authors.lastname: Yamazaki
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery*; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging / Q000601:surgery; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000637:transplantation; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D016105:Parathyroidectomy; D011859:Radiography; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D025321:Surgery, Computer-Assisted; D017256:Technetium Tc 99m Sestamibi; D014182:Transplantation, Autologous
chemical_list: D000911:Antibodies, Monoclonal; D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi