Relative contributions of technetium Tc 99m sestamibi scintigraphy, intraoperative gamma probe detection, and the rapid parathyroid hormone assay to the surgical management of hyperparathyroidism. Arch Surg 2000 May;135(5):550-5; discussion 555-7
Date
05/12/2000Pubmed ID
10807279DOI
10.1001/archsurg.135.5.550Scopus ID
2-s2.0-0034097470 (requires institutional sign-in at Scopus site) 98 CitationsAbstract
HYPOTHESIS: Technetium Tc 99m sestamibi scintigraphy, intraoperative gamma probe detection, and the rapid parathyroid hormone assay have been used to permit a directed operation in patients with hyperparathyroidism. We hypothesized that the coordinated use of these techniques might be particularly useful in patients who require a second operation for hyperparathyroidism.
DESIGN: Retrospective analysis was performed to determine the specific contribution of these technologies to the surgical management of patients with hyperparathyroidism who underwent evaluation by at least 2 of these techniques between April 1996 and October 1999.
SETTING: Patients were evaluated and treated by an endocrine tumor surgery group within a tertiary care referral center.
PATIENTS: Coordinated application of 99mTc-sestamibi scintigraphy, intraoperative gamma probe detection, and/or the rapid parathyroid hormone assay was performed in 32 patients.
RESULTS: Twenty-eight of 32 patients had primary hyperparathyroidism, 3 had multiple endocrine neoplasia type 1, and 1 had secondary hyperparathyroidism. The surgical procedure was an initial cervical exploration in 19 and a second operative procedure in 13. Parathyroidectomy was successful in all patients. A directed anatomic operation was performed in 24 patients, including 11 patients who underwent second operative procedures and 9 patients who underwent minimally invasive procedures under local anesthesia. A directed operation was facilitated by sestamibi scan in 22 of 24 patients, intraoperative gamma probe detection in 5 of 23 patients, and the rapid parathyroid hormone assay in 15 of 15 patients.
CONCLUSIONS: Coordinated application of 99mTc-sestamibi scintigraphy, intraoperative gamma probe detection, and the rapid parathyroid hormone assay allows for successful directed reoperative parathyroidectomy; a minimally invasive procedure may be performed in selected patients.
Author List
Dackiw AP, Sussman JJ, Fritsche HA Jr, Delpassand ES, Stanford P, Hoff A, Gagel RF, Evans DB, Lee JEAuthor
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdenomaHumans
Hyperparathyroidism
Monitoring, Intraoperative
Multiple Endocrine Neoplasia Type 1
Parathyroid Hormone
Parathyroid Neoplasms
Parathyroidectomy
Predictive Value of Tests
Reoperation
Retrospective Studies
Technetium Tc 99m Sestamibi
Tomography, Emission-Computed, Single-Photon