'Low dose' 99mTc-Sestamibi for radioguided surgery of primary hyperparathyroidism.
OBJECTIVE
In this study, we evaluated the efficacy of low dose (99m)Tc-Sestamibi administration for radioguided parathyroid surgery in patients with primary hyperparathyroidism (PHPT).


METHODS
Three hundred consecutive PHPT patients were studied between September, 1999 and July, 2003. Pre-operative work-up included (99m)Tc-pertechnetate/(99m)Tc-Sestamibi subtraction scintigraphy and high resolution ultrasonography (US). 37MBq of (99m)Tc-Sestamibi was injected i.v. in the operating suite approximately 10 min prior to the beginning of the surgical procedure for intraoperative radiolocalization; quick parathyroid hormone (QPTH) assays were performed.


RESULTS
Two hundred and seven of the 211 patients selected for minimally-invasive radioguided parathyroidectomy (MIRP) were successfully treated for a solitary parathyroid adenoma (PA) through a 2-2.5 cm skin incision (mean operative time 35 min, mean hospital stay 1.2 days). In the 89 patients selected for traditional bilateral neck exploration (BNE), radioguided surgery was not as successful in the identification of the PA, especially in patients with (99m)Tc-Sestamibi-avid thyroid nodules. Nevertheless, the combination of probe and QPTH measurement was very helpful in patients with multigland disease.


CONCLUSIONS
Low-dose (99m)Tc-Sestamibi administered few minutes before surgery is sufficient for MIRP in patients with high likelihood of a solitary PA and without concomitant (99m)Tc-Sestamibi-avid thyroid nodules. The combination of radioguided surgery and QPTH measurements is very useful in the early identification of unanticipated multigland disease.
Rubello
D
D
Nuclear Medicine Service, S. Maria della Misericordia Hospital, Istituto Oncologico Veneto, Viale Tre Martiri, 140, I-45100 Rovigo, Italy. domenico.rubello@libero.it
Piotto
A
A
Medi
F
F
Gross
M D
MD
Shapiro
B
B
Erba
P
P
Mariani
G
G
Pelizzo
M R
MR
D000236:Adenoma / Q000175:diagnosis / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000628:therapy*; D007430:Intraoperative Care; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000175:diagnosis / Q000628:therapy; D016105:Parathyroidectomy; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D017256:Technetium Tc 99m Sestamibi / Q000008:administration & dosage*; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi