scholarly journals Prevalence of Thymic Parathyroids in Primary Hyperparathyroidism During Radioguided Parathyroidectomy

2019 ◽  
Vol 12 ◽  
pp. 117955141986991 ◽  
Author(s):  
Sophie Dream ◽  
Brenessa Lindeman ◽  
Herbert Chen
Keyword(s):  
Primary Hyperparathyroidism ◽  
Ex Vivo ◽  
Gamma Probe ◽  
Background Level ◽  
Parathyroid Glands ◽  
Radioguided Surgery ◽  
Sestamibi Scan ◽  
Radioguided Parathyroidectomy ◽  
Ectopic Parathyroid ◽  
Clinically Significant

Background: Radioguided surgery has been an effective tool for identifying hyperfunctioning parathyroid glands during routine parathyroidectomy for hyperparathyroidism. The purpose of this study was to examine the role of radioguided surgery for the identification of intrathymic parathyroid glands. Material and Methods: Between March 2001 and February 2018, 2291 patients underwent parathyroidectomy by 1 surgeon for primary hyperparathyroidism. Of these patients, 158 (7%) were identified to have an ectopic intrathymic parathyroid gland. All patients underwent radioguided parathyroidectomy. Ex vivo radionuclide counts were used to confirm parathyroid excision with specimen radioactivity of >20% of the background level. Results: The mean age was 56 ± 1 years with 74% of the patients being female. Preoperatively, 122 patients underwent sestamibi scan, which correctly identified the affected gland 61% of the time. Mean background radionuclide count was 208 ± 7, mean ex vivo radionuclide count was 127 ± 9, with ex vivo counts of removed glands >20% in all patients. All ectopic parathyroid glands were successfully identified using gamma probe. Ex vivo counts found to be significantly higher in patients with adenomas. Patients with parathyroid adenomas also were older in age and had higher preoperative calcium levels. While 10% of patients with primary hyperparathyroidism have hyperplasia, 42% of patients with thymic parathyroids had hyperplasia. Conclusions: Radioguided parathyroidectomy is useful in detecting ectopic parathyroid glands in the thymus. Patients with hyperplasia disproportionately have clinically significant thymic parathyroid glands.

scholarly journals Preventing blind thyroid lobectomy in patients with intrathyroidal hyperfunctioning parathyroid glands with radioguided enucleation

2020 ◽  
Vol 7 (1) ◽  
pp. IJE28
Author(s):  
Sophie Dream ◽  
Brenessa Lindeman ◽  
Herbert Chen
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Gamma Probe ◽  
Parathyroid Glands ◽  
Radioguided Surgery ◽  
Thyroid Lobectomy ◽  
Abnormal Parathyroid Gland ◽  
Thyroid Parenchyma

Aim: Hyperfunctioning intrathyroidal parathyroid glands are rare and often result in thyroid lobectomy. This study examines the utility of radioguided surgery to guide enucleation of intrathyroidal parathyroids. Methods: Between December 2002 and March 2018, 2291 patients underwent parathyroidectomy by one surgeon for primary hyperparathyroidism. A total of 74 (3%) patients had an ectopic intrathyroidal parathyroid gland and underwent radioguided. Results: All of intrathyroidal parathyroid glands were localized with the gamma probe. In vivo radionuclide counts were above 120% of the background in all but three patients. All intrathyroidal parathyroids were enucleated with the guidance of the gamma probe. Conclusion: Radioguided surgery is useful for intraoperative identification of hyperfunctioning, intrathyroidal parathyroid glands. This technique allows for enucleation of the abnormal parathyroid gland, avoiding thyroid lobectomy and preserving healthy thyroid parenchyma.

scholarly journals Radioguided Parathyroidectomy with Portable Mini Gamma-Camera for the Treatment of Primary Hyperparathyroidism

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Claudio Casella ◽  
Pierluigi Rossini ◽  
Carlo Cappelli ◽  
Chiara Nessi ◽  
Riccardo Nascimbeni ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Diagnostic Accuracy ◽  
Gamma Camera ◽  
Parathyroid Glands ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Neck Ultrasound ◽  
Radioguided Parathyroidectomy ◽  
Correct Location ◽  
Preoperative Localisation

Background. A proper localisation of pathological parathyroid glands is essential for a minimally invasive approach in the surgical treatment of primary hyperparathyroidism (PHP). The recent introduction of portable mini gamma-cameras (pMGCs) enabled intraoperative scintigraphic scanning. The aim of our study is to evaluate the efficacy of this new method and compare it with the preoperative localisation surveys.Methods. 20 patients were studied; they were evaluated preoperatively by neck ultrasound andTc-sestaMIBI-scintigraphy and intraoperatively with the pMGC IP Guardian 2. The results obtained from the three evaluations were compared.Results. The pMGC presented a sensitivity of 95%, a specificity of 98.89%, and a diagnostic accuracy of 98.18%, which were higher than those of preoperative ultrasound (sensitivity 55%; specificity 95%; diagnostic accuracy 87%) and scintigraphy withTc-sestaMIBI (sensitivity 73.68%; specificity 96.05%; diagnostic accuracy 91.58%).Conclusions. The pMGC can be used effectively as an intraoperative method to find the correct location of the pathological parathyroid glands. The pMGC is more reliable than the currently used preoperative and intraoperative localisation techniques.

scholarly journals Excision of an Elusive Tiny Ectopic Parathyroid Adenoma

2017 ◽  
Vol 10 (3) ◽  
pp. 1105-1111
Author(s):  
Andre Navarro ◽  
Josanne Vassallo ◽  
Joseph Galea
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Gamma Probe ◽  
Surrounding Tissue ◽  
Uneventful Recovery ◽  
Ectopic Parathyroid Adenoma ◽  
Ectopic Parathyroid ◽  
Mediastinal Parathyroid Adenoma ◽  
Upper Mediastinum ◽  
Mediastinal Parathyroid

An elderly lady was diagnosed with primary hyperparathyroidism after being admitted to hospital with pyelonephritis and constipation. A sestamibi parathyroid scan demonstrated increased uptake in the upper mediastinum, suggesting an ectopic mediastinal parathyroid adenoma. The 4-mm adenoma was successfully removed through a mini-sternotomy incision using a gamma probe to identify the gland from the surrounding tissue. The patient made an uneventful recovery.

Value of Ultrasonography, CT and MR Imaging in the Diagnosis of Primary Hyperparathyroidism

1996 ◽  
Vol 37 (3P2) ◽  
pp. 720-726 ◽  
Author(s):  
C. Tziakouri ◽  
E. Eracleous ◽  
S. Skannavis ◽  
A. Pierides ◽  
P. Symeonides ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Primary Hyperparathyroidism ◽  
Detection Rate ◽  
Cost Effective ◽  
Clinical Results ◽  
Parathyroid Glands ◽  
Preoperative Localization ◽  
Confirmatory Test ◽  
Parathyroid Adenomas ◽  
Ectopic Parathyroid

Purpose: To evaluate the significance of preoperative localization of abnormal parathyroid glands to the surgical outcome in patients with primary hyperparathyroidism. Material and Methods: Thirty-nine patients with primary hyperparathyroidism were studied preoperatively with US (39 patients), CT (30 patients) and MR imaging (18 patients). The overall diagnostic accuracy for US was 87%, CT 66% and MR 94%. In patients with a single parathyroid adenoma US was the most cost-effective localization technique with a detection rate of 96%. CT had a lower detection rate (78%) but was of particular value for fairly large ectopic adenomas in the root of the neck. MR imaging was a good confirmatory test (93%). In patients with multiple gland disease (primary hyperplasia and multiple adenomas), no single localization study alone was sufficient. Combination of all 3 studies, however, alerted the physician to the presence of disease in more than one gland in 87% of these patients. Conclusion: US, CT and MR imaging followed by surgery performed by an experienced surgeon provided good clinical results in 39 patients with primary hyperparathyroidism. Preoperative localization was especially useful in patients with primary parathyroid hyperplasia or multiple adenomas and in patients with ectopic parathyroid adenomas in the root of the neck. We recommend identification of all abnormal parathyroid glands prior to surgery.

scholarly journals Robotic surgery using a DROP-IN beta probe – feasibility study with 68Ga-PSMA in prostate cancer specimens

2020 ◽  
Author(s):  
Francesco Collamati ◽  
Matthias van Oosterom ◽  
Micol De Simoni ◽  
Riccardo Faccini ◽  
Marta Fischetti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Nodes ◽  
Ex Vivo ◽  
Gamma Probe ◽  
Beta Particle ◽  
Radioguided Surgery ◽  
Robot Assisted ◽  
Tumor Identification ◽  
Psma Pet ◽  
Positive Lymph Nodes

Abstract Background: Recently, a flexible DROP-IN gamma-probe was introduced for robot-assisted radioguided surgery, using traditional low-energy SPECT-isotopes. This study explores the use of a novel DROP-IN beta-particle (DROP-IN b ) detection probe to support the implementation of the large number of PET-tracers available during robot-assisted tumor-receptor-targeted resections. Methods: Following engineering of the DROP-IN b probe, robotic implementation was investigated using surgical specimens. Seven prostate cancer patients with PSMA-PET positive tumors received an intraoperative injection of ~100 MBq 68 Ga-PSMA-11, followed by prostatectomy and extended pelvic lymph node dissection. Results: The probe was able to identify the position of the tumor in the prostate specimens: S/B was > 5 when pathology confirmed that the tumor was located <1 mm below the specimen surface. PSMA-PET positive lymph nodes, as found in two patients, could be identified with the DROP-IN b probe (S/B>3). Conclusions: This ex vivo study underlines the potential to use a DROP-IN b probe for intraoperative tumor identification on the prostate surface and confirmation of PSMA-PET positive lymph nodes.

scholarly journals Persistent primary hyperparathyroidism: an uncommon location for an ectopic gland - Case report and review

2012 ◽  
Vol 56 (6) ◽  
pp. 393-403 ◽  
Author(s):  
Sofia Gouveia ◽  
Dírcea Rodrigues ◽  
Luísa Barros ◽  
Cristina Ribeiro ◽  
Anabela Albuquerque ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Median Sternotomy ◽  
Parathyroid Glands ◽  
Aortopulmonary Window ◽  
Genetic Syndromes ◽  
Subtotal Parathyroidectomy ◽  
Common Causes ◽  
Ectopic Parathyroid ◽  
99Mtc Sestamibi

Primary hyperparathyroidism (PHPT) is a common endocrine disorder that mainly affects middle-aged women. Patients are usually asymptomatic. The disease might be ascribable to hyperplasia, carcinoma, and single or multiple adenomas. PHPT may be sporadic or familial, the latter comprising multiple endocrine neoplasia type 1 or 2A, familial benign hypocalciuria hypercalcemia, and hyperparathyroidism-jaw tumor syndrome. The most common causes for persistent PHPT are multiglandular disease, and missed abnormal ectopic or orthotopic parathyroid glands. Imaging localization studies should precede a new surgical intervention. Ectopic parathyroid glands are rarely located at the aortopulmonary window. For diagnosis confirmation, 99mTc-sestamibi SPECT/CT seems to be an advantageous test. Another possibility is to perform 99mTc-sestamibi followed by thoracic CT or MRI. Parathyroidectomy may be performed by means of median sternotomy, thoracotomy, or video-assisted thoracoscopy. We describe a case of persistent primary hyperparathyroidism due to the presence of an ectopic parathyroid gland found at the aortopulmonary window. As the investigation necessary to clarify the etiology of recurrent nephrolithiasis proceeded, the diagnosis of PHPT was determined. The patient underwent subtotal parathyroidectomy; nevertheless, PHPT persisted. Genetic syndromes that could account for this condition were excluded. Imaging studies available at that time were not able to locate abnormal glands; moreover, the patient refused to undergo surgical exploration. Later, the patient underwent 99mTc-sestamibi SPECT/CT, which revealed a parathyroid gland at the aortopulmonary window.

scholarly journals A DROP-IN Beta Probe for Robot-Assisted 68Ga-PSMA Radioguided Surgery: First Ex Vivo Technology Evaluation Using Prostate Cancer Specimens

2020 ◽  
Author(s):  
Francesco Collamati ◽  
Matthias van OOsterom ◽  
Micol De Simoni ◽  
Riccardo Faccini ◽  
Marta Fischetti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Nodes ◽  
Ex Vivo ◽  
Gamma Probe ◽  
Beta Particle ◽  
Radioguided Surgery ◽  
Robot Assisted ◽  
Psma Pet ◽  
Positive Lymph Nodes

Abstract Background: Recently, a flexible DROP-IN gamma-probe was introduced for robot-assisted radioguided surgery, using traditional low-energy SPECT-isotopes. In parallel, a novel approach to achieve sensitive radioguidance using beta-emitting PET-isotopes has been proposed. Integration of these two concepts would allow to exploit the use of PET-tracers during robot-assisted tumor-receptor-targeted. In this study, we’ve engineered and validated the performance of a novel DROP-IN beta-particle (DROP-INb) detector.Methods: Seven prostate cancer patients with PSMA-PET positive tumors received an additional intraoperative injection of ~70 MBq 68Ga-PSMA-11, followed by robot-assisted prostatectomy and extended pelvic lymph node dissection. The surgical specimens from these procedures were used to validate the performance of our DROP-INb probe prototype, with merged a scintillating detector with a housing optimized for a 12 mm trocar and prograsp instruments. Results: After optimization of the detector and probe housing via Monte Carlo simulations, the resulting DROP-INb probe prototype was tested in a robotic setting. In the ex vivo setting, the probe – positioned by the robot- was able to identify 68Ga-PSMA-11 containing hot-spots in the surgical specimens: signal-to-background (S/B) was > 5 when pathology confirmed that the tumor was located <1 mm below the specimen surface. 68Ga-PSMA-11 containing (and PET positive) lymph nodes, as found in two patients, were also confirmed with the DROP-INb probe (S/B>3). The rotational freedom of the DROP-IN design and the ability to manipulate the probe with the prograsp tool allowed the surgeon to perform autonomous beta tracing. Conclusions: This study demonstrates the feasibility of beta-radioguided surgery in a robotic context by means of a DROP-INb detector. When translated to an in vivo setting in the future, this technique could provide a valuable tool in detecting tumor remnants on the prostate surface and in confirmation of PSMA-PET positive lymph nodes.

Use of a Handheld, Semiconductor (Cadmium Zinc Telluride)-Based Gamma Camera in Navigation Surgery for Primary Hyperparathyroidism

2011 ◽  
Vol 77 (6) ◽  
pp. 690-693 ◽  
Author(s):  
Takaaki Fujii ◽  
Satoru Yamaguchi ◽  
Reina Yajima ◽  
Soichi Tsutsumi ◽  
Nobuyuki Uchida ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Gamma Camera ◽  
Gamma Ray ◽  
Ex Vivo ◽  
Skin Incision ◽  
Radioguided Surgery ◽  
Single Adenoma ◽  
Navigation Surgery ◽  
Imaging Device

The recent development of gamma-ray probes makes it possible to perform radioguided surgery for primary hyperparathyroidism (PHPT). There have only been a few reports, however, regarding the use of a handheld gamma camera to detect parathyroid adenoma intraoperatively. The aim of this preliminary study was to assess the efficiency of a semiconductor gamma camera (eZ-SCOPE AN) in navigation surgery for PHPT. The eZ-SCOPE is designed to be used as a handheld, regional diagnostic imaging device. Eleven consecutive patients with documented primary hyperparathyroidism underwent surgery using this compact camera. Scintigraphy images of the neck by eZ-SCOPE were acquired: 1) before skin incision; 2) after adenoma location; 3) after adenoma excision; and 4) ex vivo imaging of the specimen. In scan-positive cases by preoperative Tc-MIBI, the eZ-SCOPE revealed parathyroid adenoma in all cases (100%), whereas ultrasound and CT showed a single adenoma in 63.6 and 72.7 per cent of cases, respectively. Navigation surgery for PHPT using the eZ-SCOPE permitted intraoperative identification and removal of parathyroid adenoma in all cases. Scintigraphy images of the neck by eZ-SCOPE also revealed a single adenoma even before skin incision. Our results suggest that Tc-MIBI scintigraphy with the eZ-SCOPE is useful for navigation surgery for PHPT. The eZ-SCOPE is useful for skin marking and could be easily applied for minimally invasive radioguided parathyroidectomy in scan-positive cases.

Characteristics of Ectopic Parathyroid Glands in 145 Cases of Primary Hyperparathyroidism

2010 ◽  
Vol 16 (6) ◽  
pp. 977-981 ◽  
Author(s):  
Victoria Mendoza ◽  
Claudia Ramírez ◽  
Amparo Espinoza ◽  
Gloria González ◽  
Juan Peña ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Glands ◽  
Ectopic Parathyroid

Occult Fifth Gland Intrathyroid Parathyroid Adenoma Identified by Gamma Probe

2005 ◽  
Vol 71 (3) ◽  
pp. 264-266
Author(s):  
Todd Berland ◽  
Stephen L. Smith ◽  
Kevin L. Huguet
Keyword(s):  
Parathyroid Hormone ◽  
Thyroid Gland ◽  
Parathyroid Adenoma ◽  
Gamma Probe ◽  
Left Lobe ◽  
Minimally Invasive Parathyroidectomy ◽  
Invasive Parathyroidectomy ◽  
Sestamibi Scan ◽  
Radioguided Parathyroidectomy ◽  
Cervical Exploration

We report the case of a 54-year-old woman undergoing radioguided parathyroidectomy in whom four normal glands were identified on cervical exploration. The gamma probe was instrumental in guiding us to the adenoma in a fifth gland that was not visible and was localized to the parenchyma of the left lobe of the thyroid gland. Many surgeons do not advocate use of the gamma probe in minimally invasive parathyroidectomy and rely solely on focused exploration on the basis of a preoperative sestamibi scan and intraoperative rapid parathyroid hormone assays. This case, however, illustrates the utility of the gamma probe in parathyroid adenoma localization.

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