Minimally invasive radio-guided parathyroidectomy on a group of 452 primary hyperparathyroid patients

Summary

The aim of this study was to investigate the efficacy of minimally invasive radio-guided parathyroidectomy (MIRP) in primary hyperparathyroid (PHPT) patients. Patients, methods: 452 consecutive PHPT patients were evaluated. Inclusion criteria for MIRP were (a) evidence at scintigraphy of a solitary parathyroid adenoma (PA); (b) a clear sestamibi uptake in the PA; (c) the absence of concomitant thyroid nodules; (d) no history of familial HPT or MEN; (e) no history of previous neck irradiation. Intra-operative protocol consisted of the injection of a low 37 MBq sestamibi dose in the operating suite 10 min before surgery. A hand held 11-mm collimated gamma probe was used. Quick PTH (QPTH) was routinely measured. Results: 344 out of the 452 patients met the inclusion criteria, and MIRP was successfully performed in 321 of them (93.3%). No major intra-operative complication was recorded. MIRP required a mean operative time of 32 min, and a mean hospital stay of 1.2 d. The parathyroid to background ratio (P/B) calculated by the probe was well correlated with the P/B calculated by sestamibi SPECT (r = 0.91; p <0.01), while no significant correlation was found between the probe-calculated P/B and the P/B calculated at planar sestamibi scan. Conclusions: In our experience: a) an accurate preoperative localising imaging protocol based on planar and SPECT sestamibi scan, and neck US is effective in selecting PHPT patients for MIRP, b) the P/B calculated by sestamibi SPECT seems able to predict the probe-calculated P/B more accurately than the P/B calculated at planar scan, c) the low 37 MBq sestamibi dose protocol proved to be a safe and effective approach to perform MIRP.

Zusammenfassung

Ziel: Untersuchung zur Wirksamkeit einer minimal invasiven γ-Sonden-geführten Parathyroidektomie (MIRP) bei Patienten mit primärem Hyperparathyroidismus (pHPT). Patienten, Methoden: Ergebnisse von 452 konsekutiven pHPTPatienten wurden ausgewertet. MIRP-Einschlusskriterien: a) szintigraphisch nachgewiesenes solitäres Parathyroidadenom (PA); b) eindeutiger Sestamibi-Uptake im PA; c) fehlende Schilddrüsenknoten; d) kein Hinweis auf familiären Hyperparathyroidismus (HPT) oder genetisch bedingte multiple endokrine Neoplasie (MEN); e) keine vorausgehende Strahlentherapie der Halsregion. Intraoperatives Vorgehen: Injektion der geringen Aktivität von 37 MBq Sestamibi 10 Minuten vor der Operation. Eingesetzt wurde eine handgeführte parallel ausgerichtete 11-mm-Gamma-Messsonde. Routinemäßig erfolgte die Quick-PTH-(QPTH)-Bestimmung. Ergebnisse: 344 der 452 Patienten erfüllten die Einschlusskriterien, bei 321 (93,3%) wurde die MIRP erfolgreich vorgenommen. Es gab keine schweren intraoperativen Komplikationen. Die MIRP erforderte eine mittlere Operationsdauer von 32 Minuten und einen mittleren Krankenhausaufenthalt von 1,2 Tagen. Die durch die Messsonde errechnete Parathyroid-tobackground- Ratio (P/B) stand in guter Korrelation zur durch die Sestamibi-SPECT-Technik ermittelten P/B (r = 0,91; p <0,01), während keine signifikante Korrelation zwischen der durch die Messsonde errechneten P/B zur durch die Sestamibi- Planar-Scantechnik ermittelten P/B erkennbar war. Schlussfolgerungen: a) Eine genaue präoperative Lokalisationsdiagnostik ist auf der Grundlage der Sestamibi-Planar- und -SPECT-Scan-Technik sowie der Sonographie der Halsregion ein wirksames Instrument zur Auswahl von pHPTPatienten zur MIRP. b) Die durch Sestamibi-SPECT-Technik ermittelte P/B lässt eine exaktere Voraussage der durch Messsonde errechneten P/B zu als die durch Planar-Scan-Technik ermittelte P/B. c) Die intraoperative Injektion der geringen Aktivität von 37 MBq Sestamibi hat sich als sicheres und wirksames Vorgehen bei MIRP erwiesen.

Keywords

Hyperparathyroidism - sestamibi double-tracer scintigraphy - SPECT - neck ultrasonography - MIRP

Schlüsselwörter

Hyperparathyroidismus - Sestamibi-Szintigraphie - Doppeltracer- Methode - SPECT - Sonographie der Halsregion - MIRP

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