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A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...

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Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
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Guidelines for radioguided parathyroid surgery.

Michael Friedman1, Berk Gurpinar, Paul Schalch

  • 1Department of Otolaryngology and Bronchoesophagology, Rush University Medical Center, Chicago, IL 60602, USA. hednnek@aol.com

Archives of Otolaryngology--Head & Neck Surgery
|December 19, 2007
PubMed
Summary

Ex vivo radioactivity measurements can distinguish abnormal parathyroid tissue from normal tissue. However, this method cannot differentiate parathyroid adenomas from hyperplasia, limiting its use in diagnosing multiglandular disease.

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Area of Science:

  • Nuclear medicine
  • Endocrinology
  • Surgical pathology

Background:

  • Parathyroid adenomas are often associated with increased technetium Tc 99m sestamibi uptake.
  • The diagnostic utility of ex vivo radioactivity measurements in differentiating parathyroid tissue is not fully established.

Purpose of the Study:

  • To evaluate whether ex vivo radioactivity percentages can differentiate parathyroid adenomas from other hyperactive parathyroid tissues.
  • To determine if radioactivity levels can distinguish abnormal parathyroid tissue from normal surrounding tissues.

Main Methods:

  • Retrospective analysis of prospective data from 46 patients undergoing thyroid and parathyroid surgery.
  • Ex vivo radioactivity measurements of parathyroid adenomas, hyperplastic parathyroid glands, normal parathyroid glands, thyroid tissue, lymph nodes, and fat after technetium Tc 99m sestamibi injection.

Main Results:

  • Parathyroid adenomas showed significantly higher ex vivo radioactivity (148.5% ± 83.1%) compared to hyperplastic glands (74.6% ± 18.0%) and normal tissues (2.4%-4.5%).
  • Ex vivo radioactivity percentages successfully differentiated abnormal parathyroid tissue from normal tissues and fat.
  • No significant difference in radioactivity was observed between parathyroid adenomas and hyperplastic glands.

Conclusions:

  • Ex vivo radioactivity measurements can differentiate hyperactive parathyroid tissue from other tissues.
  • This method is not sufficient to differentiate between parathyroid adenoma and hyperplasia, thus not ruling out multiglandular disease.
  • Specimen size should be considered when interpreting ex vivo radioactivity percentages.