Abstract
Surgical neck exploration is usually made in primary hyperparathyroidism (PHPT). Localization of the adenoma or detection of hyperplasia may reduce the operation period and limit the extent of the surgery. In this study the effficacy of preoperative Tc-99m MIBI scintigraphy and intraoperative gamma probe was evaluated. Materials and Methods: Six patients with PHPT had preoperative Tc-99m MIBI parathyroid scintigraphy and intraoperative gamma probe (IGP) was used in surgical neck exploration. Results: Parathyroid adenoma was observed in 2/6 patients on scintigraphy in the right retroclavicular region and the left lobe of the thyroid. Both of them were clearly detected by IGP during the surgery and easily removed by the surgeon in a short time (35 min) with a small incision. Pathologic examination confirmed the parathyroid adenoma. No abnormal MIBI uptake was not observed in scintigraphy in 4/6 patients. Subtotal parathyroidectomy was performed in these patients. Conclusion: Preoperative Tc-99m MIBI scintigraphy and the use of IGP may limit the exploration and also the operation time and reduce surgical complications.
References
Consensus Development Conference Panel. Diagnosis and management of asymptomatic primary hyperparathyroidism: Consensus Development Coference statement. Ann Intern Med 1991; 114: 593–597.
Rodriquez JM, Tezelman S, Siperstein AE, Duh OY, Higgins C, Morita E, et al. Localization procedures in patients with persistent or recurrent hyperparathyroidism. Arch Surg 1994; 129: 870–875.
Jarhult J, Nordenstrom J, Perbeck L. Re-operation for suspect primary hyperparathyroidism. Br J Surg 1993; 80: 453–456.
Rothmund M, Diethelm I, Brunner C, Kummerle F. Diagnosis and surgical treatment of mediastinal parathyroid tumors. Ann Surg 1976; 183: 139–145.
Carter WB, Sarfati MR, Fox KA, Patton DA. Preoperative detection of sporadic parathyroid adenomas using technetium-99m-sestamibi: what role in clinical practice? Am Surg 1997; 63 (4): 317–321.
Borley NR, Collins REC, O'Doerthy M, Coakley A. Technetium-99m sestamibi parathyroid localization is accurate enough for scan-direct unilateral neck exploration. Br J Surg 1996; 83: 989–991.
Gupta VK, Karen AY, Burke GJ, Wei JP. 99m-technetium sestamibi localized solitary parathyroid adenoma as an indication for limited unilateral surgical exploration. Am J Surg 1998; 176: 409–412.
Norman J, Chleda H. Minimally invasive parathyroidectomy facilitated by intraoperative nuclear mapping. Surgery 1997; 122: 998–1004.
Casara D, Rubello D, Piotto A, Pelizzo MR. 99mTc-MIBI radio-guided minimally invasive parathyroid surgery planned on the basis of a preoperative combined 99mTc-pertechnetate/99mTc-MIBI and ultrasound imaging protocol. Eur J Nucl Med 2000; 27 (9): 1300–1304.
Rubello D, Piotto A, Pagetta C, Pelizzo M, Casara D. Ectopic parathyroid adenomas located at the carotid bifurcation. The role of preoperative Tc-99m MIBI scintigraphy and the intraoperative gamma probe procedure in surgical treatment planning. Clin Nucl Med 2001; 26 (9), 774–776.
Casara D, Rubello D, Pelizzo MR, Shapino B. Clinical role of Tc-99m O4/MIBI scan, ultrasound and intraoperative gamma probe in the performance of unilateral and minimally invasive surgery in primary hyperparathyroidism. Eur J Nucl Med 2001; 28 (9): 1351–1359.
Spiegel AM, Marx SJ, Doppman JL. Intrathyroidal parathyroid adenoma or hyperplasia. An occasional overlooked cause of surgical failure in primary hyperparathyroidism. JAMA 1975; 234: 1029–1033.
Thomson NW, Edchansen FE, Harness JK. The anatomy of primary hyperparathyroidism. Surgery 1982; 92: 814–821.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Küçük, N.Ö., Arican, P., Koçak, S. et al. Radioguided surgery in primary hyperparathyroidism. Ann Nucl Med 16, 359–362 (2002). https://doi.org/10.1007/BF02988622
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02988622