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[Radio-guided parathyroidectomy: successful intraoperative parathyroid localization diagnosis with 99mTc-sestamibi in
B Geissler1, S Gröber, N Zügel
1Klinik für Allgemein- und Viszeralchirurgie, Klinikum Augsburg.
Introduction:
In addition to ultrasonography, CT scan, MRI and venous sampling, 99mTc-MIBI scintigraphy has gained increasing acceptance in preoperative localization of abnormal parathyroid tissue. The sensitivity of this radionuclide method is 87% in primary (p), 58% in secondary (s), and 75% in recurrent hyperparathyroidism (HPT). This study evaluated the use of intraoperative nuclear mapping in patients with HPT.
Methods:
Retrospective analysis was performed in 24 patients with HPT (18 p, 4 s, 2 recurrent) undergoing a technetium-sestamibi-guided neck exploration during an 18-months period. Abnormal parathyroid tissue was localized using an intraoperative gamma probe detector 2 h after application of 700 MBq 99mTc-sestamibi and verified by pathology.
Results:
Intraoperative nuclear mapping identified 15 of 18 adenomas in patients with pHPT. The target-to-background ratio was 1.3 to 4.1 in these patients compared to 1.0 to 1.2 in undetected adenomas. In 67% of these patients we performed a minimally invasive open parathyroidectomy. In two cases of recurrent HPT the scan-guided detection of ectopic parathyroid tissue was efficient. In contrast, the method was less helpful in four patients with multiglandular disease.
Conclusion:
The intraoperative use of a gamma probe detector is highly effective in identifying parathyroid adenomas in pHPT and recurrent HPT and supports minimally invasive techniques.