[New intraoperative diagnostic methods parathyroid surgery. Adenoma localization by gamma probe].
BACKGROUND
The key to heal primary hyperparathyroidism is to find the hyper functioning parathyroid gland(s). Promoting this the perioperative isotope guided localization technique is worldwide used in the last years.


OBJECTIVE
Authors use this method since February, 2000. They present their experiences.


METHODS
At 122 patients undergoing parathyroidectomy in last 5 years with diagnosis of primary hyperparathyroidism perioperative sestamibi scanning by gamma probe was taken to localize the adenoma. Tc-99m-sestamibi was administered 90-150 minutes before starting anesthesia. The distribution of activity was measured before operation percutaneously on the neck and during operation directly at explored parathyroid regions. Finally the removed specimens were ex vivo scanned.


RESULTS
Because of the thyroid lobes also accumulate sestamibi the localizability of adenomas depended on direction of scanning. Important factor is the correct timing of isotope administration in order to achieve domination of parathyroid activity in time of measurement. Localization of adenomas by percutaneous measurement was correct in 36.1% of cases and by perioperative direct scanning in 66.4%. Furthermore, ex vivo scan of removed adenomas showed impressively high activity in all cases.


CONCLUSIONS
In their experience sestamibi scanning lightens the operation only in a part of cases but probably it will be the most important method of localization if isotope selectively accumulating in parathyroid gland could be found. For the moment the greatest profit of this method is that the ex vivo measurement indicates the success of operation with great probability.
Horányi
János
J
Semmelweis Egyetem, Altalános Orvostudományi Kar, I. Sebészeti Klinika, Budapest.
Duffek
László
L
Kemenes
Miklós
M
Szlávik
Rezso
R
Darvas
Katalin
K
Dabasi
Gabriella
G
Lakatos
Péter
P
Tóth
Miklós
M
D000236:Adenoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005720:Gamma Rays; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010279:Parathyroid Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D016105:Parathyroidectomy; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi