Revision parathyroidectomy guided by intraoperative radionuclide imaging (original) (raw)
Related papers
Med Princ …, 2009
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 radioguided 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.
Endocrine Practice, 2004
Objective: To assess the diagnostic properties of 99m Tc-sestamibi scanning (dual-phase technique) in patients with primary hyperparathyroidism and to establish the overall efficacy of this imaging technique for localization of an adenoma. Methods: The medical records of all 131 patients who underwent parathyroid scanning in a tertiary care center between January 1997 and December 2002 were reviewed. The surgical findings were used as the "gold standard" for the diagnosis of parathyroid pathologic conditions. Results: Primary hyperparathyroidism was diagnosed in 87 of the 131 patients (66.4%); of these, 76 underwent surgical treatment. In 44 patients, sestamibi scanning was also done for conditions other than primary hyperparathyroidism. 99m Tc-sestamibi scanning had a sensitivity of 79.1%, a specificity of 86.7%, a positive predictive value of 88.3%, a false-positive rate of 11.6%, and a false-negative rate of 23.3% for the diagnosis of parathyroid adenoma. Despite the apparent high sensitivity of this scanning technique, only 58.2% of the adenomas were found intraoperatively at the location predicted by the scan. Lesions in the upper neck area were missed more frequently by sestamibi scanning than were those in the lower neck area (13 of 32 versus 1 of 35, respectively) (P<0.05). Conclusion: Preoperative localization of parathyroid adenomas with use of 99m Tc-sestamibi scanning showed a limited capacity to reveal their precise location. Thus, such scans must be complemented with other studies, such as intraoperative ultrasonography and rapid parathyroid hormone assay, to ensure a successful excision if a limited surgical procedure is planned.
Medical Principles and Practice, 2009
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 radioguided 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.
Parathyroid scintigraphy and minimal invasive surgery in parathyroid adenomas
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2015
This study aims to identify the diagnostic capacity of the technetium 99m sestamibi scintigraphy with single photon emission computed tomography for localizing parathyroid pathologies. Data of 13 patients (4 males, 9 females; mean age 49.23 years; range 27 to 63 years) who had minimally invasive parathyroidectomy due to primary hyperparathyroidism at the Haseki Training and Research Hospital Ear-Nose-Throat clinic between January 2013 and December 2013 were retrospectively analyzed. Two patients were excluded due to incomplete documentation. Mean preoperative parathyroid hormone and calcium levels were 284.36 (134-1,083 pg/mL) and 11.9 (10.7-13.5 mg/dL), respectively. The operation was deemed adequate if intraoperative parathyroid hormone dropped by 50% from the preoperative level or frozen section analysis showed hypercellular gland or adenoma. Only sestamibi scintigraphy results were consistent with focal exploration findings in all patients. Focal exploration and parathyroid aden...
Presurgical Localization of Abnormal Parathyroid Glands Using a Single Injection of Tc-99m Sestamibi
Clinical Nuclear Medicine, 2002
Purpose: Scintigraphy using Tc-99m sestamibi is sensitive in localizing abnormal parathyroid glands in patients with hyperparathyroid disease (HPT). Various methods have been described to increase the sensitivity of the single-tracer technique, such as SPECT, factor analysis of dynamic structures, and use of a pinhole collimator, but often the gain in sensitivity is accompanied by a loss of specificity. Purpose: In this study, the authors compared the sensitivity and specificity of side localization of the diseased gland(s) using the double-phase single-tracer method performed with and without the addition of a pinhole collimator in the early and late phases of imaging. The combined high-resolution parallel-hole and pinhole collimator imaging protocol was further validated by investigation of interobserver and intraobserver variation. Materials and Methods: Forty-seven patients with primary HPT and 16 patients with secondary HPT examined from 1996 to 1999 with the Tc-99m sestamibi doublephase technique and who had subsequent surgery formed the basis of the study. Their histologic and follow-up data were also factored into this analysis. Tc-99m sestamibi (750 to 900 MBq; 18.9 to 24.3 mCi) was injected. Ten-minute neck and mediastinum images acquiring 1,000 K counts were obtained with the highresolution parallel-hole collimator, and a neck image containing 500 K counts was obtained with the pinhole collimator. Two to three hours later, the same parallelhole and pinhole collimator images were obtained that had the same acquisition time as the early images. Two observers who were nuclear medicine specialists independently viewed all the parallel-hole scintigrams and afterward all parallel-hole and pinhole scintigrams two times. Results: Thirty-eight (81%) of the patients with primary HPT had a single adenoma. The sensitivity and specificity for the correct side of localization were 54% and 89%, respectively, using the high-resolution parallel-hole col-limator, and 88% and 77%, respectively, with the addition of the pinhole collimator in all patients with primary HPT. In patients with secondary HPT, the sensitivity and specificity for localization of the correct side were 58% and 100%, respectively, using the high-resolution parallel-hole collimator, and 85% and 100%, respectively, with the addition of the pinhole collimator. The interobserver agreement was acceptable, with an overall agreement of 84% and a value of 0.67. The intraobserver agreement was even better, with an overall agreement of 88% and 90% and values of 0.76 and 0.79 for the two observers. Conclusions: Sensitivity is increased considerably when the pinhole collimator is added to the imaging protocol of parathyroid scintigraphy in patients with primary or secondary HPT. A loss of specificity occurred only in patients with primary HPT. The precision of the combined approach is very high.
Parathyroid gland radionuclide scanning – methods and indications
Joint Bone Spine, 2002
The usefulness of preoperative radionuclide scanning of the parathyroid glands in patients with primary or secondary hyperparathyroidism was long controversial because available techniques were of limited diagnostic efficacy. Technetium-99m-labeled sestamibi ( 99 Tc-sestamibi) is a new radiopharmaceutical agent easily detected by gamma cameras. The first parathyroid imaging studies done with 99 Tc-sestamibi about 10 years ago used a double-phase technique to separate thyroid and parathyroid tissue. Although promising, this method was less than ideal, particularly in multiple gland primary hyperparathyroidism and in secondary hyperparathyroidism. For several years, we have been using subtraction between two images acquired simultaneously, one with 99 Tc-sestamibi, which binds to thyroid and parathyroid tissue, and the other with 123-iodine, which binds only to thyroid tissue. The remarkable efficacy of this technique in both primary and secondary hyperparathyroidism invites a reappraisal of the place of radionuclide imaging as a preoperative localization procedure done to reduce the need for repeat surgery. The usefulness of this technique in selecting candidates for unilateral surgery among patients with primary hyperparathyroidism is discussed. Joint Bone Spine 2002 ; 69 : 28-36. © 2002 Éditions scientifiques et médicales Elsevier SAS parathyroid radionuclide scanning / parathyroid surgery / primary hyperparathyroidism / secondary hyperparathyroidism / sestamibi
Minimally invasive radioguided parathyroidectomy for hyperparathyroidism
Annals of Nuclear Medicine - ANN NUCL MED, 2010
Clinical or subclinical hyperparathyroidism (HPT) is one of the most common endocrine disorders. In patients with HPT who meet the indications for parathyroidectomy, complete surgical resection of all hyperfunctioning parathyroid tissue is essential for the curative treatment. The conventional surgical approach is bilateral neck exploration, whereas minimally invasive parathyroidectomy has been made possible by the introduction of 99mTc-sestamibi scintigraphy for preoperative localization of parathyroid adenomas. In minimally invasive surgery, the surgeon expects some modalities that predict complete resection of all hyperfunctioning parathyroid glands. The prevalence rate of 99mTc-sestamibi scanning for single parathyroid adenoma was widely accepted as 85–95%. Moreover, the recent developing technology of semiconductor electronics has produced useful portable γ-probes. Intraoperative navigation using these devices provides the possibility of easy and definitive identification of pa...
Minimally invasive radioguided parathyroidectomy
Biomedicine & Pharmacotherapy, 2006
The surgical management of hyperparathyroidism has evolved over the last 20 years, transitioning from routine bilateral neck exploration to, frequently, a minimally invasive approach. Adjuncts which have made this transition possible include advancements in imaging techniques which allow the pre-operative localization of adenomatous glands, the rapid parathyroid hormone assay and the use of 99-m technetium sestamibi injections the day of surgery to allow for gamma probe detection of abnormal glands. The gamma probe can help with gland localization, which can be particularly useful in a reoperative field or with glands in ectopic locations. It is also helpful in confirming that excised tissue is abnormal parathyroid tissue, alleviating the need for frozen sections during surgery. In this chapter we discuss and review radioguided minimally invasive parathyroidectomy.
Archives of Surgery, 2009
Background: Many surgeons have shown that radioguided resection of parathyroid glands can facilitate intraoperative localization in selected patients with primary hyperparathyroidism, especially in the reoperative setting. However, in patients with negative technetium Tc 99m-sestamibi (hereafter referred to as "sestamibi") scans, the usefulness of the gamma probe is unclear. Thus, we were interested in determining the role of radioguided techniques in patients with primary hyperparathyroidism and negative or nonlocalizing sestamibi scans. Design: Retrospective analysis of a prospective parathyroid database. Setting: Academic medical center. Patients: Seven hundred sixty-nine patients with primary hyperparathyroidism who had a sestamibi scan and underwent surgical invention by a single surgeon. All patients had radioguided parathyroidectomy using a handheld gamma probe. Main Outcome Measures: Radioactive counts, eucalcemia rate, and complications were compared between patients with positive and patients with negative sestamibi scans. Results: All enlarged parathyroid glands were localized with the gamma probe in patients with a negative or with a positive sestamibi scan with similar sensitivities. This occurred despite the fact that smaller parathryoid glands were present, on average, in patients with negative sestamibi scans (428 mg vs 828 mg, P=.001). Equivalent high postoperative eucalcemia rates (Ͼ98%) and low complication rates (0.5%) were achieved with radioguided techniques in both patient populations. Conclusions: Radioguided techniques are equally effective in patients with negative (nonlocalizing) sestamibi scans undergoing parathyroidectomy for primary hyperparathyroidism. Moreover, use of the gamma probe led to the detection of all parathyroid glands, including ectopically located ones. These data suggest that the gamma probe has an important role for localization of parathyroid glands in patients with negative preoperative sestamibi scans.
European Journal of Endocrinology, 2000
OBJECTIVE: To evaluate the usefulness of the combination of Tc-sestamibi/Tc-pertechnetate subtraction scintigraphy (SS) and high-resolution neck ultrasonography (US) in patients with primary hyperparathyroidism (pHPT) undergoing parathyroidectomy. DESIGN AND METHODS: Ninety-one patients with proved pHPT were studied, excluding patients with persistent or recurrent disease. There were 65 (71.4%) women and 26 (28.6%) men, with a median age of 59 years (range 18-78 years). All patients underwent both SS and US prior to surgery, and the results were compared with operative and histological findings. The intraoperative quick-parathyroid hormone assay was available for 52 (57.1%) patients. When multiglandular disease was found, both SS and US were considered truly positive only when at least two enlarged parathyroid (PT) glands had been localized. RESULTS: Eighty-three (91.2%) solitary PT adenomas and three (3.3%) carcinomas were found. Moreover, two (2.2%) patients had a double adenoma a...