Radioguided surgery in primary hyperparathyroidism: a review of the different available techniques

Area of Science:

• Endocrine Surgery
• Nuclear Medicine
• Radioguided Surgery

Background:

• Parathyroidectomy has transitioned from bilateral exploration to minimally invasive single-gland approaches.
• Advancements in presurgical localization techniques are key drivers of this surgical paradigm shift.

Purpose of the Study:

• To review the evolution and current landscape of minimally invasive radioguided parathyroidectomy.
• To discuss updated techniques including ultrasound-guided radio-guided occult lesion localization (ROLL) and novel radiotracer applications.

Main Methods:

• Review of functional imaging: double-phase scintigraphy ([^99mTc]Tc-MIBI), SPECT-CT, PET-CT ([¹⁸F]-Choline).
• Morphological imaging: ultrasound.
• Radioguided surgery techniques: [^99mTc]Tc-MIBI, ultrasound-guided ROLL, ¹²⁵I seeds, hybrid radiotracer/fluorescence methods.

Main Results:

• Minimally invasive radioguided parathyroidectomy with [^99mTc]Tc-MIBI is well-established with extensive experience.
• Emerging techniques like ultrasound-guided ROLL and ¹²⁵I seeds offer alternatives for lesion localization.
• Hybrid techniques combining radiotracer and fluorescence show promise for enhanced surgical guidance.

Conclusions:

• A diverse array of advanced techniques now complements minimally invasive radioguided parathyroidectomy.
• These innovations enhance the precision and efficacy of parathyroid gland localization and removal.