Radioguided parathyroidectomy: How does it contribute to surgery?

Area of Science:

• Endocrinology
• Surgical Oncology
• Nuclear Medicine

Background:

• Primary hyperparathyroidism is often caused by parathyroid adenoma.
• Minimally invasive parathyroidectomy (MIP) is the preferred surgical approach.
• Accurate intraoperative localization of parathyroid adenomas is crucial for successful MIP.

Purpose of the Study:

• To assess if a radioguided approach improves intraoperative adenoma detection and enables higher rates of MIP.
• To determine if the radioguided approach maintains or improves cure rates for hyperparathyroidism secondary to parathyroid adenoma.

Main Methods:

• Observational, prospective, single-center study of 254 patients with primary hyperparathyroidism (2017-2022).
• 258 procedures: 129 non-radioguided (NRS) and 129 radioguided (RS) using intraoperative gamma probe and camera.
• Radioguided techniques included intravenous 99mTc-MIBI and ultrasound-guided 99mTc-MAA injection.

Main Results:

• No significant differences in age, sex, preoperative labs, or adenoma localization via imaging between groups.
• Intraoperative surgical localization was 97.7% in both NRS and RS groups.
• RS significantly increased MIP rates (96.9% vs. 88.4%), particularly in patients with prior neck surgery (75% vs. 28%) and ectopic adenomas (93.3% vs. 71.4%).
• RS group had shorter operative times (51 min vs. 59.79 min) with similar postoperative complication rates.
• Biochemical cure rates at six months were comparable (RS: 97.7% vs. NRS: 93.8%).

Conclusions:

• Radioguided minimally invasive parathyroidectomy (MIP) is effective for ectopic adenomas and in patients with previous cervical surgery.
• The radioguided approach facilitates a higher frequency of minimally invasive procedures.
• This technique is safe, reproducible with standard operating room equipment, and suitable for endocrine surgeons.