99mTc-MIBI Radioguided Surgery for Limited Invasive Parathyroidectomy

2000 ◽  
Vol 86 (4) ◽  
pp. 370-371 ◽  
Author(s):  
Dario Casara ◽  
Domenico Rubello ◽  
Andrea Piotto ◽  
Elena Carretto ◽  
Maria Rosa Pelizzo
Keyword(s):  
Parathyroid Carcinoma ◽  
Gamma Probe ◽  
Preoperative Imaging ◽  
Radioguided Surgery ◽  
Parathyroid Surgery ◽  
Imaging Protocol ◽  
Invasive Parathyroidectomy ◽  
Wide Variability ◽  
99Mtc Mibi ◽  
Ratio Range

We report the preliminary results obtained with the intraoperative MIBI-guided gamma probe in a group of 9 patients with primary hyperparathyroidism (pHPT). These patients were selected for limited invasive parathyroid surgery on the basis of a preoperative imaging protocol consisting of a pertechnetate & perchlorate/MIBI scan combined with neck ultrasonography (US). In the operating room 50–70 MBq MIBI was injected 30 to 45 min before parathyroidectomy. The radioactivity was measured intraoperatively at three sites: parathyroid (P), thyroid (T), and background (B). The P/B, P/T, and T/B ratios were calculated. The T/B ratio was relatively constant (range, 1.5–1.8; mean, 1.6), while a wide variability was observed both for P/T ratio (range, 1.2–2.3; mean, 1.7) and P/B ratio (range, 2.1–4.0; mean, 2.9). At surgery single enlarged parathyroid glands were easily identified by means of intraoperative MIBI-guided gamma probe. Moreover, the gamma probe allowed us to perform a limited 2–2.5 cm neck incision in eight patients affected by parathyroid adenoma. In the remaining patient a parathyroid carcinoma was diagnosed and a bilateral neck exploration was performed. The intraoperative MIBI gamma probe seems to be a useful aid when limited invasive parathyroid surgery is performed.

The role of gamma probe activity counts in minimally invasive parathyroidectomy

2004 ◽  
Vol 43 (06) ◽  
pp. 190-194 ◽  
Author(s):  
A. Aydın ◽  
C. Tassci ◽  
K. Atila ◽  
M. A. Koçdor ◽  
A. Sevinç ◽  
...  
Keyword(s):  
Gamma Probe ◽  
Minimally Invasive Parathyroidectomy ◽  
The Other ◽  
Rank Test ◽  
Test Results ◽  
Invasive Parathyroidectomy ◽  
The Mean ◽  
99Mtc Mibi ◽  
Wilcoxon Rank Test

Summary Aim: The benefit of preoperative gamma probe in the diagnosis of adenoma in patients with histopathologically proven parathyroid (PT) adenomas was examined. Patients, material, methods: 20 patients with positive 99mTc MIBI uptake in PT scintigraphy with primary hyper-parathyroidism were enrolled in this study. 740 MBq 99mTc MIBI were injected 3 h before operation. Counts of four PT regions were obtained with gamma probe before surgery in the operation room. All suspected PT adenomas were resected and histopathologically diagnosed as adenomas. We also obtained counts of the resection region and the resected adenoma with gamma probe after the parathyroidectomy. Preoperative counts of adenoma bearing regions (ABR), non-adenoma bearing regions (NABR), postoperative resection region (PRR), resected adenoma counts (RA) were registered. Statistical analysis was performed by Wilcoxon rank test. Results: The mean counts of ABR, NABR, the PRR and RA were 462 ± 106, 230 ± 66, 164 ± 42, 374 ± 87, respectively. The mean counts from ABR were twofold higher than those of NABR. The PRR mean counts decreased by 64% when compared to the mean counts of ABR and by 55% when compared to the mean counts of RA. The differences in mean counts of ABR and NABR, PRR and ABR, PRR and RA (p <0.01) turned out as statistically significant. Discussion: According to our preliminary results, the region with the highest counts is at least 2 ± 0,4 times higher than the mean of the other three PT regions. Thus, it seems to be significant for PT adenoma. Resection of adenoma may be accepted as successful, if the count of ABR decreased more than 64% with decreased postoperative parathormone levels. Conclusion: This technique should not yet be applied instead of parathormone measurement or frozen technique. But it may replace the frozen technique used for confirmation of the diagnosis during the operation in the future.

scholarly journals Synchronous intrathyroidal parathyroid carcinoma and thyroid carcinoma: case report and review of the literature

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nadia De Falco ◽  
Giuseppe Santangelo ◽  
Fabrizio Chirico ◽  
Angelo Cangiano ◽  
Maria Giulia Sommella ◽  
...  
Keyword(s):  
Literature Review ◽  
Thyroid Carcinoma ◽  
Papillary Carcinoma ◽  
Parathyroid Carcinoma ◽  
Malignant Tumors ◽  
Gamma Probe ◽  
Differentiated Thyroid Carcinoma ◽  
Thyroid Carcinomas ◽  
First Case ◽  
Well Differentiated

Abstract Background Parathyroid carcinoma is a rare endocrine malignancy, rarer when synchronous with a non medullary well differentiated thyroid carcinoma. Parathyroid carcinoma accounts of 0.005% of all malignant tumors and it is responsible for less than 1% of primary hyperparathyroidism. The intrathyroidal localization of a parathyroid gland is not frequent with a reported prevalence of 0.2%. Carcinoma of parathyroids with intrathyroidal localization represents an even rarer finding, reported in only 16 cases described in literature. The rare constellation of synchronous parathyroid and thyroid carcinomas has prompted us to report our experience and perform literature review. Case presentation We herein report a case of a 63-years-old man with multinodular goiter and biochemical diagnosis of hyperparathyroidism. Total thyroidectomy with radio-guide technique using gamma probe after intraoperative sesta-MIBI administration and intraoperative PTH level was performed. The high radiation levels in the posterior thyroid lobe discovered an intrathyroidal parathyroid. Microscopic examination revealed a parathyroid main cell carcinoma at the posterior thyroidal left basal lobe, a classic papillary carcinoma at the same lobe and follicular variant of papillary carcinoma at the thyroidal right lobe. To the best of our knowledge, this is the first case documenting a synchronous multicentric non medullary thyroid carcinomas and intrathyroidal parathyroid carcinoma. Conclusions Our experience was reported and literature review underlining challenging difficulties in diagnostic workup and surgical management was carried out.

scholarly journals Computed tomography-guided preoperative localization of musculoskeletal lesions using the ROLL technique

2018 ◽  
Vol 51 (3) ◽  
pp. 147-150 ◽  
Author(s):  
Chiang Jeng Tyng ◽  
Paula Nicole Vieira Pinto Barbosa ◽  
Almir Galvão Vieira Bitencourt ◽  
Maurício Kauark Amoedo ◽  
Maria Fernanda Arruda Almeida ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Gamma Probe ◽  
Preoperative Localization ◽  
Bone Lesions ◽  
Radioguided Surgery ◽  
Previous Diagnosis ◽  
Occult Lesion ◽  
Intraoperative Localization ◽  
Lesion Localization ◽  
Musculoskeletal Lesions

Abstract Objective: To describe the preoperative localization of musculoskeletal lesions with the radioguided occult lesion localization (ROLL) technique. Materials and Methods: In all cases, computed tomography-guided injection of technetium-99m sulfur colloid was performed, directly into or near the suspicious lesion, up to 36 hours before the surgical procedure. Lesions were detected intraoperatively with a gamma probe. Results: We report the cases of six patients submitted to radioguided surgery, including three patients with bone lesions suspicious for metastasis, two patients suspected of recurrent sarcoma, and one patient with no previous diagnosis who had a nodular lesion on the left leg. Patients tolerated the procedure well, and no complications were associated with the puncture. All marked lesions were easily identified intraoperatively and were excised with clear margins. Conclusion: The ROLL technique was effective in the intraoperative localization of occult musculoskeletal lesions, demonstrating that it is a feasible and promising technique for the surgical exploration of selected cases.

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