[Minimally invasive parathyroid surgery with 99mTc-sestamibi scintigraphy and probe-radioguided surgery: preliminary...

The most common pathological finding in patients with sporadic primary hyperparathyroidism is a single adenoma. The success of parathyroid surgery is determined by the identification and removal of the responsible adenoma. The aim of our study was to minimize interventional techniques, hospital stay and overall costs of patients with parathyroid adenoma who do not require a complete neck examination.

Seven patients with biochemically confirmed hyperparathyroidism were included in our study. All the patients underwent 99mTc-Tetrofosmin and 99mTc-Pertecnetate neck scans in the days prior to the surgery. On the day of the operation, we administrated a dose of 740-925 MBq 99mTc-sestamibi. The scintigraphy study and radioguided surgery examination were performed with a 10 mm hand-held gamma probe at 2-3 hours of the administration. The counts were measured in the four neck quadrants.

We identified seven adenomas and six were removed with a 2 cm incision. The removal of the adenoma resulted in a decline in radioactivity in that quadrant, these being comparable in all the neck quadrants. Ex vivo counts identified parathyroid tissue from fat and lymph node. The histopathologic exam and a decrease of the intact PTHi levels at 30 and 60 minutes after removal of the adenoma confirmed the correct surgery.

Radioguided parathyroid surgery allows for a minimally invasive unilateral neck examination with a small scar and better cosmetic results, reduces operative and anesthetic times, requires minimal times spent in the hospital and achieves a reduction in overall cost.