Minimally invasive radionuclide-guided parathyroidectomy using 99mTc-sestamibi in patients with primary hyperparathyroidism: a single-institution experience.
OBJECTIVE
To evaluate the efficacy and usefulness of (99m)Tc-sestamibi scintigraphy and gamma probe localization of parathyroid glands in patients with primary hyperparathyroidism and establish radio-guided minimally invasive parathyroidectomy at Hussain Makki Al Jumma Center for Specialized Surgery, Kuwait.


METHODS
Twelve patients with primary hyperparathyroidism (mean age: 48 +/- 14 years; median age: 46 years; age range: 29-68 years) were evaluated. The diagnosis of hyperparathyroidism was established by elevated serum calcium and parathyroid hormone levels. All patients had a well-defined parathyroid lesion on previous standard (99m)Tc-sestamibi scintigraphy with or without ultrasound study. All had a normal thyroid gland, no history of familial hyperparathyroidism or multiple endocrine neoplasia nor any history of previous neck irradiation. On the day of surgery, patients were injected with 740 MBq (20 mCi) of (99m)Tc -sestamibi followed by a half-hour-delayed single standard pinhole view of the neck. A skin marker was placed on the basis of maximum count intensity during gamma probe localization. Patients were then sent for radio-guided minimally invasive parathyroidectomy.


RESULTS
The preoperative localization of the affected gland was successful in all cases using a gamma probe and (99m)Tc -sestamibi scintigraphy. The pathological parathyroid tissue was localized and successfully removed with the gamma probe. The histopathological diagnosis was parathyroid adenoma in 11 cases and hyperplasia in the remaining one. All patients remained disease and symptom free at 12-month follow-up.


CONCLUSIONS
Our initial experience with intraoperative use of a gamma probe to carry out minimally invasive parathyroidectomy was a useful, easy and safe procedure for treating patients with primary hyperparathyroidism.
Usmani
Sharjeel
S
Department of Nuclear Medicine, Hussain Makki Al Jumma Center for Specialized Surgery (HMJCSS), Khaitan, Kuwait. dr_shajji@yahoo.com
Khan
Haider Ali
HA
al Mohannadi
Shihab
S
Javed
Amir
A
al Nafisi
Naheel
N
abu Huda
Fawaz
F
Tuli
M
M
Amanguno
Henney G
HG
Abdulla
Majda A
MA
Al Khalidi
K
K
D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods*; D015641:Radiography, Interventional; D011877:Radionuclide Imaging; D017256:Technetium Tc 99m Sestamibi
D017256:Technetium Tc 99m Sestamibi