Focused approach to ectopic mediastinal parathyroid surgery assisted by radio-guided navigation

Onoda, Naoyoshi; Ishikawa, Tetsuro; Nishiyama, Noritoshi; Kawabe, Joji; Takashima, Tsutomu; Hirakawa, Kosei

doi:10.1007/s00595-013-0547-z

Cited by 8 publications

(6 citation statements)

References 27 publications

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“…In those cases the sensitivity of US scan was 22.2%, and that of 99m Tc-MIBI SPECT/ CT was 100%. In addition, we have reported the usefulness of radio-guided focused approach for patients with mediastinal ectopic parathyroid gland, as one of the practical application of 99m Tc-MIBI [22].…”

Section: Discussionmentioning

confidence: 99%

Strategy of operative treatment of hyperparathyroidism using US scan and <sup>99m</sup>Tc-MIBI SPECT/CT

et al. 2014

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Primary hyPerParathyroidism (pHPT) is a disease for which the diagnosis and treatment have become relatively straightforward. The criteria for diagnosis have become standardized with either elevated blood calcium levels, the presence of kidney stones, or decreased bone densitometry. The primary causes of pHPT are classically said to be 80%-85% due to adenoma, 10% -15% due to hyperplasia, and ~1% due to carcinoma, respectively. Majority of responsible lesion of pHPT is, thus, a single adenoma. The standard of care of pHPT is a surgical excision of the responsible lesion(s). Therefore, accurate localiza- abstract. We evaluated the efficacy of technetium-sestamibi ( 99m Tc-MIBI) SPECT/CT for planning parathyroidectomy in cases with primary hyperparathyroidism (pHPT), comparing with planar scintigraphy and ultrasound (US), in an aim to establish the proper surgical strategy according to the preoperative imaging studies. A retrospective review of consecutive 75 pHPT patients who had been operated on was conducted. The results of preoperative imaging modalities and the operative finding were analyzed. Seven cases were found to have multiple hyperplastic glands, and no responsible gland was found in three cases. Four cases underwent only US scan for preoperative imaging. Remaining 61 cases were found to have single adenoma, and were included in the evaluation of localization imaging. US scan, 99m Tc-MIBI planar scan and 99m Tc-MIBI SPECT/CT showed accurate localization in 77.0% (47/61), 75.4% (46/61) and 88.5% (46/52) of the evaluable cases, respectively. US and 99m Tc-MIBI planar scan demonstrated consistent result in 42 cases (68.9%), and those cases showed accurate localization in 90.5% (38/42). When both US and 99m Tc-MIBI SPECT/CT was consistent, all 37 lesions had been correctly indicated. No clinico-pathological features were suggested to influence in demonstrating the localization, other than only 99m Tc-MIBI SPECT/CT exhibited 100% sensitivity in ectopic glands. Combination of US and 99m Tc-MIBI SPECT/CT certainly contributes to the planning of minimally invasive operation in cases with pHPT by indicating correct localization of single adenoma.Key words: Primary hyperparathyroidism, Technetium-sestamibi ( 99m Tc-MIBI), SPECT/CT tion analysis is important.The imaging techniques that have been used to identify the location of responsible lesion(s) are technetium-thallium subtraction scan, technetium-sestamibi ( 99m Tc-MIBI) scan, ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT) [1], venous sampling of parathyroid hormone, and angiography. To date, the best results have been found using either US or technetium imaging.The sensitivity of US for detecting a single parathyroid adenoma was 57 to 87 % [2][3][4][5][6][7]. However, parathyroid US is dependent on the experience of the operator [8] and has a suboptimal detection rate for multinodular thyroid disease and silent areas, such as the mediastinum, tracheoesophageal groove, and retroesophageal region [9]. Therefore, the practical choic...

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confidence: 99%

Strategy of operative treatment of hyperparathyroidism using US scan and <sup>99m</sup>Tc-MIBI SPECT/CT

et al. 2014

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“…Previous reports have described how the gamma probe can eliminate the need for frozen section to confirm that excised tissue is indeed parathyroid tissue versus thyroid, or lymphatic tissue [15]. The probe can also assist in locating parathyroid adenomas in ectopic or unusual locations by scanning the operative field for higher counts [16,17]. Although this remains a helpful use of the gamma probe in selected cases, it is not the most helpful aspect of the probe in routine cases.…”

Section: Discussionmentioning

confidence: 99%

Use of the Gamma Probe to Identify Multigland Disease in Primary Hyperparathyroidism

Tobin

Ayers

Rajaei

et al. 2016

Int. J. Endo. Oncol.

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Aim The purpose of this study was to determine threshold gamma probe counts to distinguish single adenoma (SA) from multigland disease (MGD) during radioguided parathyroidectomy. Methods A retrospective analysis of 1656 patients was performed. Ex vivo counts of the first excised gland were taken and recorded as a percentage of background counts. Results 69.4% of MGD patients had counts below the 50% threshold. The 50% threshold correctly grouped 72.8% of our cohort. Counts of more than 100% were accurate for grouping SA, with only 6.8% of patients with counts more than 100% having MGD. Conclusions The gamma probe can aid surgeons in deciding to continue neck exploration if MGD is suspected or wait for labs to confirm cure if SA is suspected.

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“…[7] Nevertheless, "in vivo" versus "ex vivo" count under the guidance of gamma probe ascertains that there is no pathological tissue left and thereby the surgery can be completed in the centers where rapid PTH level counting is not available. [8] In conclusion, parathyroid surgery performed under the guidance of parathyroid scintigraphy and gamma probe facilitates the localization and surgical excision of ectopic parathyroid pathologies.…”

Section: Discussionmentioning

confidence: 95%

Excision of mediastinal parathyroid adenoma under the guidance of gamma probe

Sakallı¹

2016

Turk Gogus Kalp Dama

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ÖZParatiroid adenomları primer hiperparatiroidizmin en sık nedenidir. Bu yazıda yorgunluk, hiperkalsemi ve hiperparatiroidisi olan 44 yaşında bir erkek hasta sunuldu. Paratiroid sintigrafisi ve torasik bilgisayarlı tomografisinde, ektopik olarak ön mediastende yerleşim gösteren paratiroid adenomu ile uyumlu bir lezyon görüldü. Paratiroid adenomu ameliyat sırası gama prob kılavuzluğunda başarı ile eksize edildi. Paratiroid adenomlarının yerleşiminin ameliyat öncesinde belirlenmesi gereklidir. Bu nedenle; ultrasonografi, paratiroid sintigrafisi ve paratiroid sintigrafisi pozitif olan hastalarda ameliyat sırasında yapılan gama prob kılavuzluğu tanı ve cerrahi tedavinin başarısı için çok önemlidir.Anah tar söz cük ler: Gama prob; ameliyat sırası; paratiroid adenomu. ABSTRACTParathyroid adenomas are the most frequent cause of primary hyperparathyroidism. In this article, we report a 44-year-old male patient with fatigue, hypercalcemia and hyperparathyroidism. Parathyroid scintigraphy and thoracic computed tomography revealed a lesion consistent with parathyroid adenoma ectopically located in the anterior mediastinum. The parathyroid adenoma was excised successfully under the guidance of intraoperative gamma probe. It is essential to determine the localization of parathyroid adenomas preoperatively. Therefore; ultrasonography, parathyroid scintigraphy and guidance of intraoperative gamma probe in patients with positive parathyroid scintigraphy are crucial for diagnosis and success of surgical treatment.Keywords: Gamma probe; intraoperative; parathyroid adenoma.Primary hyperparathyroidism (PHPT) is among the rarely encountered endocrine disorders and frequently manifests with hypercalcemia. Its incidence in adult population is approximately less than 1%. Whilst adenoma in a single parathyroid gland accounts for 85% to 90% of PHPT patients, hyperplasia is responsible for the etiology in 10% to 15% and parathyroid carcinoma is responsible for the etiology in 1% to 2%. Parathyroid adenomas are localized adjacent to thyroid gland by 80% to 90%, whereas they are ectopic by 10%. Ectopic adenomas are found in the anterior mediastinum primarily in the parathymic localization.[1]The main scanning methods used in the diagnosis of primary hyperparathyroidism include ultrasonography and parathyroid scintigraphy performed using technetium-99m (99mTc) methoxyisobutylisonitrile (sestamibi). Computed tomography (CT) and magnetic resonance imaging (MRI) are useful additional scanning methods particularly to localize ectopic parathyroid adenomas.[2] The use of combined radiological methods such as scintigraphy and ultrasonography or scintigraphy and CT enhances the success of clinical approach. For this purpose, the use of hybrid scanning systems such as single-photon emission computed tomography (SPECT)/CT is preferred. SPECT/CT gives more information on the anatomic localization of the lesion particularly in ectopic lesions and in the cases with the history of neck surgery.[3] The basic therapeutic approach for PHPT is surgery. Surgic...

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Focused approach to ectopic mediastinal parathyroid surgery assisted by radio-guided navigation

Abstract: Intraoperative radio-guided navigation is a useful tool for the focused removal of an ectopic mediastinal parathyroid by providing instant feedback to help guide the surgeon, while also providing precise localization of lesions.

Cited by 8 publications

References 27 publications

Strategy of operative treatment of hyperparathyroidism using US scan and <sup>99m</sup>Tc-MIBI SPECT/CT

Strategy of operative treatment of hyperparathyroidism using US scan and <sup>99m</sup>Tc-MIBI SPECT/CT

Use of the Gamma Probe to Identify Multigland Disease in Primary Hyperparathyroidism

Excision of mediastinal parathyroid adenoma under the guidance of gamma probe

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