Document Detail


Intraoperative localization of parathyroid glands with gamma counter probe in primary hyperparathyroidism: a prospective study.
MedLine Citation:
PMID:  12113540     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Technetium 99m-sestamibi imaging might be the best method to localize abnormal parathyroid glands. No studies to date have compared preoperative imaging and intraoperative gamma probe localization in patients with primary hyperparathyroidism. STUDY DESIGN: This prospective study included 20 arbitrarily selected patients with primary hyperparathyroidism, verified by elevated serum ionized calcium and intact parathyroid hormone concentrations and low serum phosphatase level. Each patient underwent both preoperative imaging study of the parathyroid glands with technetium 99m-sestamibi (dose 740MBq) and intraoperative localization with a handheld gamma probe. Full collar exploration served as the gold standard. RESULTS: Hypercalcemia and hypophosphatemia normalized in each patient. A single parathyroid adenoma was confirmed histologically in 16 and hyperplasia (4 abnormal glands) in 4 patients. None of the patients had multiple adenomas. The sensitivity of the preoperative scan was 81% (13 of 16 patients) in adenoma patients and 100% (4 of 4 patients) in hyperplasia. The corresponding specificity was 88% and 100%. Intraoperatively only 8 of 16 adenomas were correctly detected (sensitivity 50%), and none of the hyperplastic glands were correctly detected. CONCLUSIONS: In unselected patients with primary hyperparathyroidism, preoperative technetium 99m-sestamibi imaging is more accurate than intraoperative gamma probe detection in localizing abnormal parathyroid glands.
Authors:
Rauni A Saaristo; Jorma J O Salmi; Tiit Kööbi; Vainö Turjanmaa; Juhani A Sand; Isto H Nordback
Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  195     ISSN:  1072-7515     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  2002 Jul 
Date Detail:
Created Date:  2002-07-12     Completed Date:  2002-08-01     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  19-22     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University Hospital of Tampere, Finland.
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MeSH Terms
Descriptor/Qualifier:
Adenoma / complications,  radionuclide imaging*,  surgery*
Adult
Aged
Female
Humans
Hyperparathyroidism / etiology
Hyperplasia / pathology
Intraoperative Period
Male
Middle Aged
Parathyroid Glands / pathology
Parathyroid Neoplasms / complications,  radionuclide imaging*,  surgery*
Prospective Studies
Radiopharmaceuticals / diagnostic use*
Sensitivity and Specificity
Technetium Tc 99m Sestamibi / diagnostic use*
Chemical
Reg. No./Substance:
0/Radiopharmaceuticals; 109581-73-9/Technetium Tc 99m Sestamibi

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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