open access

Vol 68, No 4 (2017)
Original paper
Published online: 2017-05-26
Submitted: 2016-04-30
Accepted: 2016-07-14
Get Citation

Minimally invasive radioguided parathyroid surgery using low-dose Tc-99m-MIBI — comparison with standard high dose

Ali Jangjoo, Ramin Sadeghi, Zohreh Mousavi, Masoud Mohebbi, Mahtab Khaje, Mehdi Asadi
DOI: 10.5603/EP.a2017.0031
·
Pubmed: 28553700
·
Endokrynologia Polska 2017;68(4):398-401.

open access

Vol 68, No 4 (2017)
Original Paper
Published online: 2017-05-26
Submitted: 2016-04-30
Accepted: 2016-07-14

Abstract

Introduction: Surgery remains the most effective treatment for primary hyperparathyroidism (PHPT). Minimally invasive radioguided parathyroidectomy (MIRP) is a common technique for detecting and excising abnormal parathyroid glands. The aim of this study was to compare injections of low-dose and high-dose (99m) Tc methoxy isobutyl isonitrile (MIBI) for intraoperative localisation of parathyroid adenomas by means of a gamma probe in patients with primary hyperparathyroidism (PHPT).

Material and methods: Thirty patients with PHPT and a preoperative diagnosis of parathyroid adenoma were enrolled between 2010 and 2012. They were considered as Group B and underwent MIRP using 5 mCi Tc-99m MIBI, and their perioperative data were compared with twenty patients treated with conventional 20 mCi Tc-99m MIBI previously (Group A).

Results: Group A was made up of 20 patients (mean age, 41.55 years; 14 women and 6 men), and group B included 30 patients (mean age, 40.43 years; 19 women and 11 men). The mean serum parathyroid hormone (PTH) and calcium values were recorded pre- and postoperatively. The mean follow-up period for the patients in the two groups was 18.4 and 16.5 months, respectively. Pre-operative evaluation demonstrated that the groups were statistically similar. Intraoperative data and success rate of surgery showed no difference between the two groups. No significant complication was detected after surgeries and no recurrence happened in either of the two groups during the follow-up period.

Conclusions: A new protocol of MIRP using low doses of Tc-99m-MIBI resulted in an excellent success rate. Comparing results of the study, we conclude that low-dose Tc-99m-MIBI may be preferred for identification of parathyroid adenomas intraoperatively by means of a gamma probe in PHPT patients because it appears to be as effective as high-dose Tc-99m-MIBI.

Abstract

Introduction: Surgery remains the most effective treatment for primary hyperparathyroidism (PHPT). Minimally invasive radioguided parathyroidectomy (MIRP) is a common technique for detecting and excising abnormal parathyroid glands. The aim of this study was to compare injections of low-dose and high-dose (99m) Tc methoxy isobutyl isonitrile (MIBI) for intraoperative localisation of parathyroid adenomas by means of a gamma probe in patients with primary hyperparathyroidism (PHPT).

Material and methods: Thirty patients with PHPT and a preoperative diagnosis of parathyroid adenoma were enrolled between 2010 and 2012. They were considered as Group B and underwent MIRP using 5 mCi Tc-99m MIBI, and their perioperative data were compared with twenty patients treated with conventional 20 mCi Tc-99m MIBI previously (Group A).

Results: Group A was made up of 20 patients (mean age, 41.55 years; 14 women and 6 men), and group B included 30 patients (mean age, 40.43 years; 19 women and 11 men). The mean serum parathyroid hormone (PTH) and calcium values were recorded pre- and postoperatively. The mean follow-up period for the patients in the two groups was 18.4 and 16.5 months, respectively. Pre-operative evaluation demonstrated that the groups were statistically similar. Intraoperative data and success rate of surgery showed no difference between the two groups. No significant complication was detected after surgeries and no recurrence happened in either of the two groups during the follow-up period.

Conclusions: A new protocol of MIRP using low doses of Tc-99m-MIBI resulted in an excellent success rate. Comparing results of the study, we conclude that low-dose Tc-99m-MIBI may be preferred for identification of parathyroid adenomas intraoperatively by means of a gamma probe in PHPT patients because it appears to be as effective as high-dose Tc-99m-MIBI.

Get Citation

Keywords

primary hyperparathyroidism; radioguided parathyroidectomy; radiation exposure

About this article
Title

Minimally invasive radioguided parathyroid surgery using low-dose Tc-99m-MIBI — comparison with standard high dose

Journal

Endokrynologia Polska

Issue

Vol 68, No 4 (2017)

Article type

Original paper

Pages

398-401

Published online

2017-05-26

DOI

10.5603/EP.a2017.0031

Pubmed

28553700

Bibliographic record

Endokrynologia Polska 2017;68(4):398-401.

Keywords

primary hyperparathyroidism
radioguided parathyroidectomy
radiation exposure

Authors

Ali Jangjoo
Ramin Sadeghi
Zohreh Mousavi
Masoud Mohebbi
Mahtab Khaje
Mehdi Asadi

References (24)
  1. Bilezikian JP, Silverberg SJ. Clinical spectrum of primary hyperparathyroidism. Rev Endocr Metab Disord. 2000; 1(4): 237–245.
  2. Kim HGu, Kim WY, Woo SUk, et al. Minimally invasive parathyroidectomy with or without intraoperative parathyroid hormone for primary hyperparathyroidism. Ann Surg Treat Res. 2015; 89(3): 111–116.
  3. Soyder A, Ünübol M, Ömürlü İK, et al. Minimally invasive parathyroidectomy without using intraoperative parathyroid hormone monitoring or gamma probe. Ulus Cerrahi Derg. 2015; 31(1): 9–14.
  4. Kaplan EL, Yashiro T, Salti G. Primary hyperparathyroidism in the 1990s. Choice of surgical procedures for this disease. Ann Surg. 1992; 215(4): 300–317.
  5. Rose DM, Wood TF, Van Herle AJ, et al. Long-term management and outcome of parathyroidectomy for sporadic primary multiple-gland disease. Arch Surg. 2001; 136(6): 621–626.
  6. Quillo AR, Bumpous JM, Goldstein RE, et al. Minimally invasive parathyroid surgery, the Norman 20% rule: is it valid? Am Surg. 2011; 77(4): 484–487.
  7. Stack BC, Moore ER, Belcher RH, et al. Hormone, relationships of parathyroid gamma counts, and adenoma mass in minimally invasive parathyroidectomy. Otolaryngol Head Neck Surg. 2012; 147(6): 1035–1040.
  8. Rubello D, Pelizzo MR, Casara D. Nuclear medicine and minimally invasive surgery of parathyroid adenomas: a fair marriage. Eur J Nucl Med Mol Imaging. 2003; 30(2): 189–182.
  9. Sackett WR, Barraclough B, Reeve TS, et al. Worldwide trends in the surgical treatment of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy. Arch Surg. 2002; 137(9): 1055–1059.
  10. García-Talavera P, García-Talavera JR, González C, et al. Efficacy of in-vivo counting in parathyroid radioguided surgery and usefulness of its association with scintigraphy and intraoperative PTHi. Nucl Med Commun. 2011; 32(9): 847–852.
  11. Fujii T, Yamaguchi S, Yajima R, et al. Use of a handheld, semiconductor (cadmium zinc telluride)-based gamma camera in navigation surgery for primary hyperparathyroidism. Am Surg. 2011; 77(6): 690–693.
  12. Tardin L, Prats E, Andrés A, et al. [Ectopic parathyroid adenoma: Scintigraphic detection and radioguided surgery]. Rev Esp Med Nucl. 2011; 30(1): 19–23.
  13. Jangjoo A, Forghani MN, Memar B, et al. Minimally Invasive Radio-guided Surgery for Hyperparathyroidism: An Experience with Tc-99m Sestamibi. Iran J Nucl Med. 2009; 17(1): 12–7.
  14. Caudle AS, Brier SE, Calvo BF, et al. Experienced radio-guided surgery teams can successfully perform minimally invasive radio-guided parathyroidectomy without intraoperative parathyroid hormone assays. Am Surg. 2006; 72(9): 785–9; discussion 790.
  15. Ikeda Y, Takayama J, Takami H. Minimally invasive radioguided parathyroidectomy for hyperparathyroidism. Ann Nucl Med. 2010; 24(4): 233–240.
  16. Murphy C, Norman J. The 20% rule: A simple, instantaneous radioactivity measurement defines cure and allows elimination of frozen sections and hormone assays during parathyroidectomy. Surgery. 1999; 126(6): 1023–1029.
  17. Bekiş R, Celik P, Uysal B, et al. Exposure of surgical staff in surgical probe applications in radioguided parathyroidectomy. Eur Arch Otorhinolaryngol. 2008; 265(12): 1545–1548.
  18. Kristoffersen US, Straalman K, Schmidt G, et al. Radiation exposure to surgical staff during hyperthermic isolated limb perfusion with 99m Technetium labeled red blood cells. Int J Hyperthermia. 2009 Feb. ; 25(1): 86–9.
  19. Rubello D, Mariani G, Pelizzo MR. Minimally invasive radio-guided parathyroidectomy on a group of 452 primary hyperparathyroid patients: refinement of preoperative imaging and intraoperative procedure. Nuklearmedizin. 2007; 46(3): 85–92.
  20. Rubello D, Mariani G, Al-Nahhas A, et al. Minimally invasive radio-guided parathyroidectomy: long-term results with the 'low 99mTc-sestamibi protocol'. Nuclear medicine communications. 2006 Sep. ; 27(9): 709–13.
  21. You CJ, Zapas JL. Diminished dose minimally invasive radioguided parathyroidectomy: a case for radioguidance. Am Surg. 2007; 73(7): 669–72; discussion 673.
  22. Assadi M, Yarani M, Zakavi SR, et al. Sentinel node mapping in papillary thyroid carcinoma using combined radiotracer and blue dye methods. Endokrynol Pol. 2014; 65(4): 281–286.
  23. Dabbagh Kakhki VR, Aliakbarian H, Fattahi A, et al. Effect of radiotracer injection volume on the success of sentinel node biopsy in early-stage breast cancer patients. Nucl Med Commun. 2013; 34(7): 660–663.
  24. Tibblin S, Bizard JP, Bondeson AG, et al. Primary hyperparathyroidism due to solitary adenoma. A comparative multicentre study of early and long-term results of different surgical regimens. Eur J Surg. 1991; 157(9): 511–515.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Via MedicaWydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl