Intraoperative Gamma Probe Localization of Parathyroid Adenomas

Sullivan, Daniel P.; Scharf, Stephen C.; Komisar, Arnold

doi:10.1097/00005537-200105000-00030

Cited by 20 publications

(6 citation statements)

References 14 publications

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“…We adapted an imaging strategy similar to Norman and Cheda [16] , who performed scintigraphy on the day of surgery. In a series of 35 patients, Sullivan et al [18] localized 34 adenomas using preoperative scintigraphy and 33 adenomas with an intraoperative gamma probe. Similarly, Kumar et al [19] successfully localized parathyroid adenomas in all 29 patients in their series.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Radionuclide-Guided Parathyroidectomy Using <sup>99m</sup>Tc-Sestamibi in Patients with Primary Hyperparathyroidism: A Single-Institution Experience

et al. 2009

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Objective: To evaluate the efficacy and usefulness of ^99mTc-sestamibi scintigraphy and gamma probe localization of parathyroid glands in patients with primary hyperparathyroidism and establish radio-guided minimally invasive parathyroidectomy at Hussain Makki Al Jumma Center for Specialized Surgery, Kuwait. Subjects and Methods: Twelve patients with primary hyperparathyroidism (mean age: 48 ± 14 years; median age: 46 years; age range: 29–68 years) were evaluated. The diagnosis of hyperparathyroidism was established by elevated serum calcium and parathyroid hormone levels. All patients had a well-defined parathyroid lesion on previous standard ^99mTc-sestamibi scintigraphy with or without ultrasound study. All had a normal thyroid gland, no history of familial hyperparathyroidism or multiple endocrine neoplasia nor any history of previous neck irradiation. On the day of surgery, patients were injected with 740 MBq (20 mCi) of ^99mTc -sestamibi followed by a half-hour-delayed single standard pinhole view of the neck. A skin marker was placed on the basis of maximum count intensity during gamma probe localization. Patients were then sent for radio-guided minimally invasive parathyroidectomy. Results: The preoperative localization of the affected gland was successful in all cases using a gamma probe and ^99mTc -sestamibi scintigraphy. The pathological parathyroid tissue was localized and successfully removed with the gamma probe. The histopathological diagnosis was parathyroid adenoma in 11 cases and hyperplasia in the remaining one. All patients remained disease and symptom free at 12-month follow-up. Conclusions: Our initial experience with intraoperative use of a gamma probe to carry out minimally invasive parathyroidectomy was a useful, easy and safe procedure for treating patients with primary hyperparathyroidism.

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Section: Discussionmentioning

confidence: 99%

Minimally Invasive Radionuclide-Guided Parathyroidectomy Using <sup>99m</sup>Tc-Sestamibi in Patients with Primary Hyperparathyroidism: A Single-Institution Experience

et al. 2009

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“…Intraoperative radionuclide-guided dissection is useful in the removal of ectopic parathyroid glands. [ 14 15 ] Intraoperative confirmation by frozen section is also helpful. In our patients, frozen section was done to confirm the hyperfunctioning parathyroid tissue.…”

Section: Discussionmentioning

confidence: 99%

Mediastinal Parathyroid Adenoma Removal by Video-Assisted Thoracoscopic Surgery

Abdulsalam

Devanayagam

Santosham

et al. 2021

Annals of African Medicine

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Ectopic parathyroid adenomas in the mediastinum are rare causes of primary hyperparathyroidism. We report two cases of mediastinal parathyroid adenoma. Functioning parathyroid lesion was localized with the help of nuclear single-photon emission computed tomography scan in both the patients. Video assisted thoracoscopic surgical (VATS) removal of the parathyroid lesions were done. Intraoperative confirmation of parathyroid adenoma was done by frozen section. Further confirmation was done by routine histopathological examination of specimen postoperatively. One patient had left vocal cord paralysis postoperatively. Localization by functional imaging is essential. Minimally invasive methods such as VATS are useful in removing mediastinal parathyroid hyperfunctioning lesions, which carries early postoperative recovery and less complications.

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“…They demonstrated 94% accuracy in predicting the location of a parathyroid adenoma using this technique. 17 There have been multiple reports of successful intraoperative localization of intrathymic and intrathoracic ectopic parathyroid glands. [18][19][20][21] One such case describes the in vivo identification of an intrathymic adenoma with radionuclide counts 2.5 times greater than the background levels.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Thymic Parathyroids in Primary Hyperparathyroidism During Radioguided Parathyroidectomy

Dream

Lindeman

Chen

2019

Clin Med Insights Endocrinol Diabetes

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Background: Radioguided surgery has been an effective tool for identifying hyperfunctioning parathyroid glands during routine parathyroidectomy for hyperparathyroidism. The purpose of this study was to examine the role of radioguided surgery for the identification of intrathymic parathyroid glands. Material and Methods: Between March 2001 and February 2018, 2291 patients underwent parathyroidectomy by 1 surgeon for primary hyperparathyroidism. Of these patients, 158 (7%) were identified to have an ectopic intrathymic parathyroid gland. All patients underwent radioguided parathyroidectomy. Ex vivo radionuclide counts were used to confirm parathyroid excision with specimen radioactivity of >20% of the background level. Results: The mean age was 56 ± 1 years with 74% of the patients being female. Preoperatively, 122 patients underwent sestamibi scan, which correctly identified the affected gland 61% of the time. Mean background radionuclide count was 208 ± 7, mean ex vivo radionuclide count was 127 ± 9, with ex vivo counts of removed glands >20% in all patients. All ectopic parathyroid glands were successfully identified using gamma probe. Ex vivo counts found to be significantly higher in patients with adenomas. Patients with parathyroid adenomas also were older in age and had higher preoperative calcium levels. While 10% of patients with primary hyperparathyroidism have hyperplasia, 42% of patients with thymic parathyroids had hyperplasia. Conclusions: Radioguided parathyroidectomy is useful in detecting ectopic parathyroid glands in the thymus. Patients with hyperplasia disproportionately have clinically significant thymic parathyroid glands.

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Intraoperative Gamma Probe Localization of Parathyroid Adenomas

Abstract: The gamma probe is a useful tool that complements a well-performed localization study. It is most useful in patients who have multiple or ectopic adenomas or have had prior parathyroid surgery.

Cited by 20 publications

References 14 publications

Minimally Invasive Radionuclide-Guided Parathyroidectomy Using <sup>99m</sup>Tc-Sestamibi in Patients with Primary Hyperparathyroidism: A Single-Institution Experience

Minimally Invasive Radionuclide-Guided Parathyroidectomy Using <sup>99m</sup>Tc-Sestamibi in Patients with Primary Hyperparathyroidism: A Single-Institution Experience

Mediastinal Parathyroid Adenoma Removal by Video-Assisted Thoracoscopic Surgery

Prevalence of Thymic Parathyroids in Primary Hyperparathyroidism During Radioguided Parathyroidectomy

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