Utility of an intraoperative gamma probe in the surgical management of secondary or tertiary hyperparathyroidism.
BACKGROUND
In primary hyperparathyroidism the gamma probe is effective, but its role in secondary hyperparathyroidism is unclear. We investigated the utility of the probe in the surgical management of secondary and tertiary hyperparathyroidism.


METHODS
The value of the probe in guiding resection of parathyroids was determined prospectively in 29 patients with secondary or tertiary hyperparathyroidism. Resected tissues with radioactivity of greater than 20% as compared with the wound bed was considered hyperfunctional parathyroid and was confirmed histologically.


RESULTS
The probe was helpful in guiding resection in 13% of the hyperplastic glands, including ectopic glands and those not detected preoperatively. The gamma probe confirmed the presence of hyperfunctional parathyroid after resection with a sensitivity and specificity of 97% and 92%, respectively.


CONCLUSIONS
The probe is particularly useful in confirming the presence of hyperfunctional parathyroids after resection. It also is useful in identifying ectopic localizations, but its value is limited in guiding surgery for secondary or tertiary disease.
Jorna
Francisca H
FH
Department of Surgery/Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Jager
Pieter L
PL
Lemstra
Clara
C
Wiggers
Theo
T
Stegeman
Coen A
CA
Plukker
John T M
JT
D015902:Gamma Cameras; D005720:Gamma Rays; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging / Q000601:surgery; D007432:Intraoperative Period; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000601:surgery; D016105:Parathyroidectomy; D011446:Prospective Studies; D011877:Radionuclide Imaging