[New intraoperative diagnostic methods parathyroid surgery. Adenoma localization by gamma probe]

The key to heal primary hyperparathyroidism is to find the hyper functioning parathyroid gland(s). Promoting this the perioperative isotope guided localization technique is worldwide used in the last years.

Authors use this method since February, 2000. They present their experiences.

At 122 patients undergoing parathyroidectomy in last 5 years with diagnosis of primary hyperparathyroidism perioperative sestamibi scanning by gamma probe was taken to localize the adenoma. Tc-99m-sestamibi was administered 90-150 minutes before starting anesthesia. The distribution of activity was measured before operation percutaneously on the neck and during operation directly at explored parathyroid regions. Finally the removed specimens were ex vivo scanned.

Because of the thyroid lobes also accumulate sestamibi the localizability of adenomas depended on direction of scanning. Important factor is the correct timing of isotope administration in order to achieve domination of parathyroid activity in time of measurement. Localization of adenomas by percutaneous measurement was correct in 36.1% of cases and by perioperative direct scanning in 66.4%. Furthermore, ex vivo scan of removed adenomas showed impressively high activity in all cases.

In their experience sestamibi scanning lightens the operation only in a part of cases but probably it will be the most important method of localization if isotope selectively accumulating in parathyroid gland could be found. For the moment the greatest profit of this method is that the ex vivo measurement indicates the success of operation with great probability.