Intraoperative adjuncts in surgery for primary hyperparathyroidism

Harrison, Barney; Triponez, Frédéric

doi:10.1007/s00423-009-0532-6

Cited by 64 publications

(53 citation statements)

References 125 publications

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“…However, randomized studies show that in patients with positive Tc-MIBI scintigraphy, there is no added value to support the use of intraoperative iPTH measurement. 1 In fact, our current study revealed that in all cases with a positive Tc-MIBI scan, iPTH levels are decreased after the removal of a single adenoma. These results are compatible with those of previous studies that report that even without iPTH measurements, radioguided surgery results in an excellent cure rate, at least in selected cases of single adenomas.…”

Section: Discussionsupporting

confidence: 46%

“…Some studies also recommend the use of intraoperative iPTH assay for multigland disease. 1,21,22 The iPTH assay can reliably be used for patients with multigland disease with an accuracy similar to that shown for single-adenoma cases. 21,22 The Tc-MIBI scan is not specific for parathyroid tissue, and thyroid nodules also accumulate Tc-MIBI.…”

Section: Discussionmentioning

confidence: 73%

“…[1][2][3] Intraoperative intact parathyroid hormone (iPTH) measurements have been proposed as an effective assay in surgery for PHPT. [4][5][6] Circulating concentrations of iPTH decline dramatically within minutes following surgical excision of hyperfunctioning parathyroid glands.…”

mentioning

confidence: 99%

“…Thus, intraoperative iPTH monitoring is useful for confirming complete removal of hyperfunctioning parathyroid glands. 1,7,8 On the other hand, technetium-99m sestamibi (Tc-MIBI) scintigraphy is a useful preoperative diagnostic tool in PHPT. 9,10 There have been some reports of radio-guided surgery for PHPT.…”

mentioning

confidence: 99%

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Could the eZ-SCOPE AN Gamma Camera Replace Intraoperative Measurement of iPTH for PHPT?

Fujii

Yajima

Yamaguchi

et al. 2012

International Surgery

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Intraoperative intact parathyroid hormone (iPTH) measurements have been proposed as an effective assay in surgery for primary hyperparathyroidism (PHPT). We have demonstrated the efficiency of the use of a hand-held gamma camera, eZ-SCOPE AN, with technetium-99m sestamibi (Tc-MIBI) scintigraphy for navigation surgery for PHPT. The aim of this preliminary study was to assess the possibility that the eZ-SCOPE AN can replace the measurement of intraoperative iPTH in surgery for PHPT. Sixteen consecutive patients with documented primary hyperparathyroidism underwent surgery using this compact camera. iPTH was routinely measured preoperatively and 10 minutes after the complete removal of adenoma. All patients had a well-defined parathyroid lesion identified on preoperative Tc-MIBI. The eZ-SCOPE revealed hyperfunctioning parathyroid glands in all cases. iPTH levels were decreased in all cases after the removal of adenomas. Our results suggest that this gamma camera is useful for confirming complete resection of endocrinologically active tissue in surgery for PHPT. In selective patients with scan-positive cases identified by preoperative Tc-MIBI, the eZ-SCOPE may replace the intraoperative iPTH assay in surgery for PHPT.Key words: Primary hyperparathyroidism -Navigation surgery -Gamma cameraSestamibi scintigraphy -Intact PTH On the other hand, technetium-99m sestamibi (Tc-MIBI) scintigraphy is a useful preoperative diagnostic tool in PHPT. 9,10 There have been some reports of radio-guided surgery for PHPT. [11][12][13][14][15][16][17][18] We have recently demonstrated that in scan-positive cases identified by preoperative Tc-MIBI, Tc-MIBI scintigraphy with the use of a hand-held gamma camera, the eZ-SCOPE AN, is useful for navigation surgery for PHPT and minimally invasive parathyroidectomy. 18 The eZ-SCOPE AN is designed to be used as a hand-held, regional diagnostic imaging device, which is a new compact-type semiconductor gamma camera based on the use of a cadmium-zinctelluride (CdZnTe) detector. [18][19][20] In the current preliminary study, we assessed the possibility of using the eZ-SCOPE AN in surgery to replace the measurement of intraoperative iPTH for PHPT. Patients and MethodsSixteen consecutive patients with documented PHPT who underwent surgery by the same surgical team in the Department of General Surgical Science, Graduate School of Medicine, Gunma University, from May 2006 to April 2011, were enrolled in this study. The patients with clinical and laboratory findings of PHPT were evaluated by Tc-MIBI scintigraphy and neck ultrasound and computed tomography (CT). Suspected multigland disease or negative scintigraphy cases were excluded from this study. The diagnosis of PHPT was based on hypercalcemia documented on at least two occasions and an elevated iPTH level. All the patients included in this study gave their informed consent, and the research project was authorized by the Committee for Ethical Research of the Graduate School of Medicine, Gunma University.The eZ-SCOPE is designed to be used as a hand...

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Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 73%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Could the eZ-SCOPE AN Gamma Camera Replace Intraoperative Measurement of iPTH for PHPT?

Fujii

Yajima

Yamaguchi

et al. 2012

International Surgery

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“…110 In this case intra operative measurement of PTH serum level gives the surgeon the certainty of having removed the pathological gland responsible for PHPT. 111 Recent technological developments, including the option of intra operative measurement of PTH, endoscopic technique and mainly the utilization of intra operative gamma probe, justify the success of minimally invasive surgical procedures. [112][113][114] The mini invasive procedures are summarized in Table 4.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

Percivale

Gnerre²,

Damonte³

et al. 2015

Ital J Med

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Primary hyperparathyroidism (PHPT) is a disease caused by overactive secretion of parathyroid hormone (PTH) with a concurrent alteration of the phosphocalcemic metabolism: commonly we found an association between hypercalcemic status and elevated PTH plasma levels or not properly normal. Widespread screening of serum calcium introduced in the 70's has made PHPT a relatively common disease: in these cases hypercalcemia is quickly diagnosed and in the western world the disease tends to appear with not specific symptoms such as fatigue mood disturbance and cognitive impairments.1 The main cause is represented by a solitary parathyroid adenoma (80-85% of cases) (Figure 1): the remaining 15-20% of cases are represented by conditions of diffuse glandular hyperplasia ( Figure 2) and multiple adenomas. A small percentage of patients presents with typical familial forms of multiple endocrine neoplasia type 1 (MEN 1) and multiple endocrine neoplasia type 2 (MEN 2) syndromes.2,3 Primary hyperparathyroidism generally occurs with higher rate in a population older than 55 years: it occurs 2-3 times more frequently in women than in men and has a higher prevalence in postmenopausal women. Approximately 80% of patients with PHPT are asymptomatic being the asymptomatic hypercalcemic form the most representative: signs and symptoms, when present, are due to prolonged hypercalcemic status than to elevate serum levels of PTH. 4,5 The clinical manifestation remains variable ranging from the normocalcemic to the hypercalcemic PHPT form. 6,7 Methods of research ABSTRACTPrimary hyperparathyroidism (PHPT) is a clinical condition characterized by overactive parathyroid gland secretion of parathyroid hormone with concurrent alteration of the phosphocalcemic metabolism. We present a literature review on primary hyperparathyroidism addressing key on clinical presentation, causes, medical and surgical treatment at the best of our knowledge. Based on this review we confirm the role of serum calcium and serum level examination, as well as we define the definitive treatment for PHPT being parathyroidectomy. In case of contraindication for surgery, medical treatment can play a relevant role.

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Systematic review of intravenous methylene blue in parathyroid surgery

Patel

Chadwick

Harrison

et al. 2012

British Journal of Surgery

104

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Intraoperative adjuncts in surgery for primary hyperparathyroidism

Abstract: Literature review provides the basis for clear recommendations on the use of intraoperative PTH at surgery for PHPT. There is little evidence to support the use of RGP, MB, routine frozen section, and intraoperative neuromonitoring.

Cited by 64 publications

References 125 publications

Could the eZ-SCOPE AN Gamma Camera Replace Intraoperative Measurement of iPTH for PHPT?

Could the eZ-SCOPE AN Gamma Camera Replace Intraoperative Measurement of iPTH for PHPT?

Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

Systematic review of intravenous methylene blue in parathyroid surgery

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