Individualised Timing of Radio-Guided Parathyroidectomy Using Multi-Phase SPECT/CT Increases In Vivo Sensitivity and...

Area of Science:

• Endocrine Surgery
• Nuclear Medicine Imaging
• Minimally Invasive Procedures

Background:

• Minimally invasive parathyroidectomy is standard for primary hyperparathyroidism.
• Challenges exist with small or ectopic parathyroid adenomas.
• Radio-guidance improves adenoma identification, but in vivo accuracy needs enhancement.

Purpose of the Study:

• To evaluate if individualized timing of minimally invasive radio-guided parathyroidectomy (MIRGP) improves outcomes.
• To assess the impact of multi-phase 99mTc-MIBI SPECT/CT on radio-guidance effectiveness.
• To determine benefits in sensitivity, specificity, and accuracy of MIRGP.

Main Methods:

• A randomized clinical trial involving 100 adult patients with primary hyperparathyroidism.
• Patients were assigned to conventional (dual-phase) or multi-phase SPECT/CT with individualized MIRGP.
• Preoperative multi-phase 99mTc-MIBI SPECT/CT guided individualized MIRGP timing.

Main Results:

• Individualized MIRGP (Group II) showed significantly shorter operating times (p=0.003).
• In vivo sensitivity and accuracy of radio guidance were 100% in Group II versus 85.1% and 90.4% in Group I (p=0.046 and p=0.021).
• No significant differences were observed in in vivo specificity or ex vivo parameters between groups.

Conclusions:

• Individualized timing of MIRGP using multi-phase SPECT/CT enhances in vivo radio-guidance sensitivity and accuracy.
• This optimized approach leads to reduced operative times.
• Rapid radionuclide washout in some parathyroid adenomas necessitates individualized timing strategies.