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Parathyroid scintigraphy and minimal invasive surgery in parathyroid adenomas

Year 2015, Volume: 25 Issue: 4, 205 - 213, 25.09.2015

Abstract

Objectives: This study aims to identify the diagnostic capacity of the technetium 99m sestamibi scintigraphy with single photon emission computed tomography for localizing parathyroid pathologies. Patients and Methods: Data of 13 patients 4 males, 9 females; mean age 49.23 years; range 27 to 63 years who had minimally invasive parathyroidectomy due to primary hyperparathyroidism at the Haseki Training and Research Hospital Ear-Nose-Throat clinic between January 2013 and December 2013 were retrospectively analyzed. Two patients were excluded due to incomplete documentation. Results: Mean preoperative parathyroid hormone and calcium levels were 284.36 134-1,083 pg/mL and 11.9 10.7-13.5 mg/dL , respectively. The operation was deemed adequate if intraoperative parathyroid hormone dropped by 50% from the preoperative level or frozen section analysis showed hypercellular gland or adenoma. Only sestamibi scintigraphy results were consistent with focal exploration findings in all patients. Focal exploration and parathyroid adenoma excision via minimally invasive parathyroidectomy were successfully carried out in 10 patients with single adenoma confirmed by sestamibi. Conclusion: Technetium 99m sestamibi scintigraphy with single photon emission computed tomography and frozen section analysis may provide more meaningful information and be more advantageous compared to other preoperative localization techniques.

References

  • Kamani F, Najafi A, Mohammadi SS, Tavassoli S, Shojaei SP. Correlation of biochemical markers of primary hyperparathyroidism with single adenoma weight and volume. Indian J Surg 2013;75:102-5.
  • Khorasani N, Mohammadi A. Effective factors on the sensitivity of preoperative sestamibi scanning for primary hyperparathyroidism. Int J Clin Exp Med 2014;7:2639-44.
  • Palazzo FF, Delbridge LW. Minimal-access/ minimally invasive parathyroidectomy for primary hyperparathyroidism. Surg Clin North Am 2004;84:717-34.
  • Westerdahl J, Bergenfelz A. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: five-year follow-up of a randomized controlled trial. Ann Surg 2007;246:976-80.
  • Sidhu S, Neill AK, Russell CF. Long-term outcome of unilateral parathyroid exploration for primary hyperparathyroidism due to presumed solitary adenoma. World J Surg 2003;27:339-42.
  • Denham DW, Norman J. Bilateral neck exploration for all parathyroid patients is an operation for the history books. Surgery 2003;134:513.
  • Brunaud L, Zarnegar R, Wada N, Ituarte P, Clark OH, Duh QY. Incision length for standard thyroidectomy and parathyroidectomy: when is it minimally invasive? Arch Surg 2003;138:1140-3.
  • Zawawi F, Mlynarek AM, Cantor A, Varshney R, Black MJ, Hier MP, et al. Intraoperative parathyroid hormone level in parathyroidectomy: which patients benefit from it? J Otolaryngol Head Neck Surg 2013;42:56.
  • Augustine MM, Bravo PE, Zeiger MA. Surgical treatment of primary hyperparathyroidism. Endocr Pract 2011;17:75-82.
  • Carneiro-Pla DM, Solorzano CC, Lew JI, Irvin GL. Long-term outcome of patients with intraoperative parathyroid level remaining above the normal range during parathyroidectomy. Surgery 2008;144:989-93.
  • Greene AB, Butler RS, McIntyre S, Barbosa GF, Mitchell J, Berber E, et al. National trends in parathyroid surgery from 1998 to 2008: a decade of change. J Am Coll Surg 2009;209:332-43.
  • Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 2002;235:665-70.
  • Mihai R, Palazzo FF, Gleeson FV, Sadler GP. Minimally invasive parathyroidectomy without intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism Br J Surg 2007;94:42-7.
  • Mariani G, Gulec SA, Rubello D, Boni G, Puccini M, Pelizzo MR, et al. Preoperative localization and radioguided parathyroid surgery. J Nucl Med 2003;44:1443-58.
  • Haber RS, Kim CK, Inabnet WB. Ultrasonography for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism: comparison with (99m)technetium sestamibi scintigraphy. Clin Endocrinol (Oxf) 2002;57:241-9.
  • Ruda JM, Hollenbeak CS, Stack BC Jr. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg 2005;132:359-72.
  • Weigel TL, Murphy J, Kabbani L, Ibele A, Chen H. Radioguided thoracoscopic mediastinal parathyroidectomy with intraoperative parathyroid hormone testing. Ann Thorac Surg 2005;80:1262-5.
  • Casara D, Rubello D, Pelizzo MR, Shapiro B. Clinical role of 99mTcO4/MIBI scan, ultrasound and intra- operative gamma probe in the performance of unilateral and minimally invasive surgery in primary hyperparathyroidism. Eur J Nucl Med 2001;28:1351-9.
  • De Feo ML, Colagrande S, Biagini C, Tonarelli A, Bisi G, Vaggelli L, et al. Parathyroid glands: combination of (99m)Tc MIBI scintigraphy and US for demonstration of parathyroid glands and nodules. Radiology 2000;214:393-402.
  • Sackett WR, Barraclough B, Reeve TS, Delbridge LW. Worldwide trends in the surgical treatment of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy. Arch Surg 2002;137:1055-9.
  • Allendorf J, DiGorgi M, Spanknebel K, Inabnet W, Chabot J, Logerfo P. 1112 consecutive bilateral neck explorations for primary hyperparathyroidism. World J Surg 2007;31:2075-80.
  • Lee NC, Norton JA. Multiple-gland disease inprimary hyperparathyroidism: a function of operative approach? Arch Surg 2002;137:896-9.
  • Lavely WC, Goetze S, Friedman KP, Leal JP, Zhang Z, Garret-Mayer E, et al. Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual- phase (99m)Tc-sestamibi parathyroid scintigraphy. J Nucl Med 2007;48:1084-9.
  • Clerici T, Brandle M, Lange J, Doherty GM, Gauger PG. Impact of intraoperative parathyroid hormone monitoring on the prediction of multiglandular parathyroid disease. World J Surg 2004;28:187-92.
  • Carneiro-Pla DM, Solorzano CC, Irvin GL. Consequences of targeted parathyroidectomy guided by localization studies without intraoperative parathyroid hormone monitoring. J Am Coll Surg 2006;202:715-22.
  • Rubello D, Casara D, Giannini S, Piotto A, De Carlo E, Muzzio PC, et al. Importance of radio-guided minimally invasive parathyroidectomy using hand- held gamma probe and low (99m)Tc-MIBI dose. Technical considerations and long-term clinical results. Q J Nucl Med 2003;47:129-38.

Paratiroid adenomlarda paratiroid sintigrafi ve minimal invaziv cerrahi

Year 2015, Volume: 25 Issue: 4, 205 - 213, 25.09.2015

Abstract

Amaç: Bu çalışmada, paratiroid patolojileri lokalize etmede tek foton emisyon bilgisayarlı tomografi ile teknesyum 99m sestamibi sintigrafinin diyagnostik kapasitesi tanımlandı.Hastalar ve Yöntemler: Ocak 2013-Aralık 2013 tarihleri arasında Haseki Eğitim ve Araştırma Hastanesi Kulak-Burun-Boğaz Kliniğinde primer hiperparatiroidizm nedeniyle minimal invaziv paratiroidektomi yapılan 13 hastanın 4 erkek, 9 kadın; ort. yaş 49.23 yıl; dağılım 27-63 yıl verileri retrospektif olarak incelendi. İki hasta eksik belge nedeniyle çalışma dışı bırakıldı.Bulgular: Ameliyat öncesi ortalama paratiroid hormonu ve kalsiyum seviyeleri sırasıyla 284.36 134-1083 pg/mL ve 11.9 10.7-13.5 mg/dL idi. Ameliyat sırası paratiroid hormonunun ameliyat öncesi seviyenin %50 altına düşmesi veya dondurulmuş kesit incelemesinin hiperselüler bez veya adenoma göstermesi halinde ameliyat yeterli kabul edildi. Tüm hastalarda, sadece sestamibi sintigrafi sonuçları ile fokal eksplorasyon sonuçları uyumluydu. Sestamibi ile tek adenoma tespit edilen 10 hastada minimal invaziv paratiroidektomi yoluyla fokal eksplorasyon ve paratiroid adenoma eksizyonu başarıyla yapıldı.Sonuç: Tek foton emisyon bilgisayarlı tomografi ile teknesyum 99m sestamibi sintigrafi ve dondurulmuş kesit analizi diğer ameliyat öncesi lokalizasyon tekniklerine göre daha anlamlı bilgiler sağlayıp daha avantajlı olabilir

References

  • Kamani F, Najafi A, Mohammadi SS, Tavassoli S, Shojaei SP. Correlation of biochemical markers of primary hyperparathyroidism with single adenoma weight and volume. Indian J Surg 2013;75:102-5.
  • Khorasani N, Mohammadi A. Effective factors on the sensitivity of preoperative sestamibi scanning for primary hyperparathyroidism. Int J Clin Exp Med 2014;7:2639-44.
  • Palazzo FF, Delbridge LW. Minimal-access/ minimally invasive parathyroidectomy for primary hyperparathyroidism. Surg Clin North Am 2004;84:717-34.
  • Westerdahl J, Bergenfelz A. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: five-year follow-up of a randomized controlled trial. Ann Surg 2007;246:976-80.
  • Sidhu S, Neill AK, Russell CF. Long-term outcome of unilateral parathyroid exploration for primary hyperparathyroidism due to presumed solitary adenoma. World J Surg 2003;27:339-42.
  • Denham DW, Norman J. Bilateral neck exploration for all parathyroid patients is an operation for the history books. Surgery 2003;134:513.
  • Brunaud L, Zarnegar R, Wada N, Ituarte P, Clark OH, Duh QY. Incision length for standard thyroidectomy and parathyroidectomy: when is it minimally invasive? Arch Surg 2003;138:1140-3.
  • Zawawi F, Mlynarek AM, Cantor A, Varshney R, Black MJ, Hier MP, et al. Intraoperative parathyroid hormone level in parathyroidectomy: which patients benefit from it? J Otolaryngol Head Neck Surg 2013;42:56.
  • Augustine MM, Bravo PE, Zeiger MA. Surgical treatment of primary hyperparathyroidism. Endocr Pract 2011;17:75-82.
  • Carneiro-Pla DM, Solorzano CC, Lew JI, Irvin GL. Long-term outcome of patients with intraoperative parathyroid level remaining above the normal range during parathyroidectomy. Surgery 2008;144:989-93.
  • Greene AB, Butler RS, McIntyre S, Barbosa GF, Mitchell J, Berber E, et al. National trends in parathyroid surgery from 1998 to 2008: a decade of change. J Am Coll Surg 2009;209:332-43.
  • Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 2002;235:665-70.
  • Mihai R, Palazzo FF, Gleeson FV, Sadler GP. Minimally invasive parathyroidectomy without intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism Br J Surg 2007;94:42-7.
  • Mariani G, Gulec SA, Rubello D, Boni G, Puccini M, Pelizzo MR, et al. Preoperative localization and radioguided parathyroid surgery. J Nucl Med 2003;44:1443-58.
  • Haber RS, Kim CK, Inabnet WB. Ultrasonography for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism: comparison with (99m)technetium sestamibi scintigraphy. Clin Endocrinol (Oxf) 2002;57:241-9.
  • Ruda JM, Hollenbeak CS, Stack BC Jr. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg 2005;132:359-72.
  • Weigel TL, Murphy J, Kabbani L, Ibele A, Chen H. Radioguided thoracoscopic mediastinal parathyroidectomy with intraoperative parathyroid hormone testing. Ann Thorac Surg 2005;80:1262-5.
  • Casara D, Rubello D, Pelizzo MR, Shapiro B. Clinical role of 99mTcO4/MIBI scan, ultrasound and intra- operative gamma probe in the performance of unilateral and minimally invasive surgery in primary hyperparathyroidism. Eur J Nucl Med 2001;28:1351-9.
  • De Feo ML, Colagrande S, Biagini C, Tonarelli A, Bisi G, Vaggelli L, et al. Parathyroid glands: combination of (99m)Tc MIBI scintigraphy and US for demonstration of parathyroid glands and nodules. Radiology 2000;214:393-402.
  • Sackett WR, Barraclough B, Reeve TS, Delbridge LW. Worldwide trends in the surgical treatment of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy. Arch Surg 2002;137:1055-9.
  • Allendorf J, DiGorgi M, Spanknebel K, Inabnet W, Chabot J, Logerfo P. 1112 consecutive bilateral neck explorations for primary hyperparathyroidism. World J Surg 2007;31:2075-80.
  • Lee NC, Norton JA. Multiple-gland disease inprimary hyperparathyroidism: a function of operative approach? Arch Surg 2002;137:896-9.
  • Lavely WC, Goetze S, Friedman KP, Leal JP, Zhang Z, Garret-Mayer E, et al. Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual- phase (99m)Tc-sestamibi parathyroid scintigraphy. J Nucl Med 2007;48:1084-9.
  • Clerici T, Brandle M, Lange J, Doherty GM, Gauger PG. Impact of intraoperative parathyroid hormone monitoring on the prediction of multiglandular parathyroid disease. World J Surg 2004;28:187-92.
  • Carneiro-Pla DM, Solorzano CC, Irvin GL. Consequences of targeted parathyroidectomy guided by localization studies without intraoperative parathyroid hormone monitoring. J Am Coll Surg 2006;202:715-22.
  • Rubello D, Casara D, Giannini S, Piotto A, De Carlo E, Muzzio PC, et al. Importance of radio-guided minimally invasive parathyroidectomy using hand- held gamma probe and low (99m)Tc-MIBI dose. Technical considerations and long-term clinical results. Q J Nucl Med 2003;47:129-38.
There are 26 citations in total.

Details

Primary Language English
Journal Section Research Article
Authors

Murat Haluk Özkul This is me

Melek Uyar This is me

Özlem Bayram This is me

Burak Dikmen This is me

Publication Date September 25, 2015
Published in Issue Year 2015 Volume: 25 Issue: 4

Cite

APA Özkul, M. H., Uyar, M., Bayram, Ö., Dikmen, B. (2015). Parathyroid scintigraphy and minimal invasive surgery in parathyroid adenomas. The Turkish Journal of Ear Nose and Throat, 25(4), 205-213.
AMA Özkul MH, Uyar M, Bayram Ö, Dikmen B. Parathyroid scintigraphy and minimal invasive surgery in parathyroid adenomas. Tr-ENT. September 2015;25(4):205-213.
Chicago Özkul, Murat Haluk, Melek Uyar, Özlem Bayram, and Burak Dikmen. “Parathyroid Scintigraphy and Minimal Invasive Surgery in Parathyroid Adenomas”. The Turkish Journal of Ear Nose and Throat 25, no. 4 (September 2015): 205-13.
EndNote Özkul MH, Uyar M, Bayram Ö, Dikmen B (September 1, 2015) Parathyroid scintigraphy and minimal invasive surgery in parathyroid adenomas. The Turkish Journal of Ear Nose and Throat 25 4 205–213.
IEEE M. H. Özkul, M. Uyar, Ö. Bayram, and B. Dikmen, “Parathyroid scintigraphy and minimal invasive surgery in parathyroid adenomas”, Tr-ENT, vol. 25, no. 4, pp. 205–213, 2015.
ISNAD Özkul, Murat Haluk et al. “Parathyroid Scintigraphy and Minimal Invasive Surgery in Parathyroid Adenomas”. The Turkish Journal of Ear Nose and Throat 25/4 (September 2015), 205-213.
JAMA Özkul MH, Uyar M, Bayram Ö, Dikmen B. Parathyroid scintigraphy and minimal invasive surgery in parathyroid adenomas. Tr-ENT. 2015;25:205–213.
MLA Özkul, Murat Haluk et al. “Parathyroid Scintigraphy and Minimal Invasive Surgery in Parathyroid Adenomas”. The Turkish Journal of Ear Nose and Throat, vol. 25, no. 4, 2015, pp. 205-13.
Vancouver Özkul MH, Uyar M, Bayram Ö, Dikmen B. Parathyroid scintigraphy and minimal invasive surgery in parathyroid adenomas. Tr-ENT. 2015;25(4):205-13.