Utility of an intraoperative gamma probe in the surgical management of secondary or tertiary hyperparathyroidism

Jorna, Francisca H.; Jager, Pieter L.; Lemstra, Clara; Wiggers, Theo; Stegeman, Coen A.; Plukker, John

doi:10.1016/j.amjsurg.2007.05.059

Cited by 14 publications

(15 citation statements)

References 29 publications

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“…Rubello et al [22] reported that the counts were more than 40% of the background in all adenomas and one dominant hyperplasic gland. Other investigators showed that the counts were higher than 20% of the background in the hyperplasic glands [24,25,30,31]. Jorna et al [30] reported high sensitivity (97%) and specificity (92%).…”

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

Early and delayed pinhole MIBI SPECT in detecting hyperfunctioning parathyroid glands

Gültekin¹,

Kr²,

Tuğ³

et al. 2011

Nuclear Medicine Communications

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Section: Discussionmentioning

confidence: 95%

“…Other investigators showed that the counts were higher than 20% of the background in the hyperplasic glands [24,25,30,31]. Jorna et al [30] reported high sensitivity (97%) and specificity (92%). In our patient group, sensitivity and specificity were found to be 92 and 75% for in-vivo counts and 83 of 100% for ex-vivo counts.…”

Section: Discussionmentioning

confidence: 95%

Early and delayed pinhole MIBI SPECT in detecting hyperfunctioning parathyroid glands

Gültekin¹,

Kr²,

Tuğ³

et al. 2011

Nuclear Medicine Communications

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“…Several adjuncts that have contributed to safe and successful parathyroidectomies in patients with primary HPT have been applied to patients with secondary (2) and tertiary (3) HPT as well [3, 6, 17, 18, 23, 24, 27, 29]. The focus of this investigation was the utility of one of these adjuncts, intraoperative PTH (ioPTH) monitoring.…”

Section: Discussionmentioning

confidence: 99%

Secondary and Tertiary Hyperparathyroidism: The Utility of ioPTH Monitoring

et al. 2010

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Background The aim of this study was to examine the utility of intraoperative parathyroid hormone (ioPTH) monitoring in patients with secondary (2) and tertiary (3) hyperparathyroidism (HPT). Materials and methods We identified 105 patients with 2HPT (n=33) and 3HPT (n=72) who underwent ioPTH monitoring during parathyroidectomy. Data are reported as mean ± SEM. Results The 2HPT patients underwent 17 subtotal, 10 total, and 6 re-exploratory parathyroidectomies, while 3HPT patients underwent 54 subtotal, 15 limited, and 3 re-exploratory parathyroidectomies. The percent decrease from the baseline ioPTH level at 5, 10, and 15 minutes after parathyroid resection respectively were 72 ± 3%, 76 ± 3%, and 76 ± 3% in patients with 2HPT, and 52 ± 6%, 60 ± 4%, and 69 ± 4% in patients with 3HPT. IoPTH levels failed to drop >50% from baseline in 5 patients (2HPT: n=2, 3HPT: n=3) who were normocalcemic at last follow-up. IoPTH did not alter the surgical approach in any 2HPT patients, but did alter management in 25% of 3HPT patients (15 limited resections and 3 supernumerary glands). Normocalcemia was achieved in 97% of 2HPT and 99% of 3HPT patients and 2 patients developed recurrent disease. Conclusion IoPTH levels fell by >50% in nearly 95% of patients with 2HPT and 3HPT, and reliably predicted post-operative cure. While the use of ioPTH did not alter surgical management in any patient with 2HPT, this rapid PTH assay impacted the surgical care of a quarter of the patients with 3HPT and may prove to be a useful adjunct in this group of patients.

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“…One of these advantages is the omission of frozen section in patients who have ex vivo to background count ratios greater than 20%—the so-called “20% rule” for RGP described by Norman (19). This rule has been effectively utilized in patients undergoing initial parathyroidectomy for primary, secondary, and tertiary HPT (18, 20, 21). Our findings confirm the efficacy of the “20% rule” in reoperative neck patients.…”

Section: Discussionmentioning

confidence: 99%

Radioguided parathyroidectomy for hyperparathyroidism in the reoperative neck

Pitt

Panneerselvan

Sippel

et al. 2009

Surgery

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Background The purpose of this study was to determine if radioguided parathyroidectomy (RGP) is effective for hyperparathyroidism (HPT) in the reoperative neck. Methods We retrospectively reviewed all patients with HPT and a history of neck surgery who underwent RGP over a 7-year period. Data are reported as mean ± SEM. Results We identified 110 patients with primary (n=94), secondary (n=7), or tertiary (n=9) HPT who underwent 138 previous neck operations. The average hospital stay was 0.6 ± 0.1 days. The in and ex vivo counts obtained with the gamma probe were 310 ± 26 and 130 ± 13, respectively. The ex vivo percentage of background was 69 ± 9%, and virtually all resected parathyroids had ex vivo counts ≥ 20%. Following RGP, 96% of patients were cured, and 4.5% experienced complications (all transient). Cure rates after RGP significantly decreased as the number of previous neck surgeries increased (P=0.002). Additionally, reoperative neck patients with single adenomas were more likely to experience cure than patients with hyperplasia (P=0.02). Conclusions These results illustrate that RGP is valuable adjunct in the reoperative neck. In addition, RGP allows similar lengths of stay, efficacy, and complication rates as those reported for patients undergoing initial parathyroidectomy.

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Utility of an intraoperative gamma probe in the surgical management of secondary or tertiary hyperparathyroidism

Cited by 14 publications

References 29 publications

Early and delayed pinhole MIBI SPECT in detecting hyperfunctioning parathyroid glands

Early and delayed pinhole MIBI SPECT in detecting hyperfunctioning parathyroid glands

Secondary and Tertiary Hyperparathyroidism: The Utility of ioPTH Monitoring

Radioguided parathyroidectomy for hyperparathyroidism in the reoperative neck

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