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Current Medical Imaging

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ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

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Research Article

The Comparison of Low and High-dose Scintigraphy findings in Patients with Primary Parathyroid Lesions in which Intraoperative Gamma-probe was Applied

Author(s): Ceylan Sule* and Yilmaz Necati

Volume 20, 2024

Published on: 07 July, 2023

Article ID: e260423216210 Pages: 9

DOI: 10.2174/1573405620666230426143033

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Abstract

Objective: We aimed to evaluate the effectiveness of high-dose and low-dose use of radioactive material in intraoperative gamma probe application methods in patients diagnosed with primary hyperparathyroidism and planned for surgery.

Methods: 47 patients with primary hyperparathyroidism underwent minimally-invasive parathyroid surgery (MIS) after preoperative imaging studies consisting of ultrasonography (USG) and sestamibi parathyroid scintigraphy (SPS) showed a possible primary parathyroid lesion (PPL). All patients received Tc-99 sestamibi on day-of-surgery imaging (DOSI) to help with the localization of a primary parathyroid lesion (PPL) via both DOSI and intraoperative gamma probe (IGP). Patients in Group I were administered 20-25 mCi Tc-99m sestamibi (methoxy isobutyl isonitrile) and images were obtained at the 20th and 120th minutes. Patients in Group II were administered 8-10 mCi doses and images were obtained at the 20th and 40th minutes. Two nuclear medicine specialists independently evaluated the images. Lesions in the localizations determined by DOSI and IGP were compared with the histopathological results of these lesions.

Results: 47 patients, 35 females, and 12 males were included in the study. The mean age of 28 patients in the first group given the high dose was 54 (41-60), and the mean age was 48 (42-57) in the second group given the low dose (p=0.011). In the group given low-dose radioactive material during intraoperative gamma probe application, the observer's sensitivity, specificity, positive, and negative predictive values for finding pathology were 61.1, 100, 100, and 12.5, respectively. In the group given high-dose radioactive material, the same values were 90.9, 33.3, 50, and 83.3, respectively. While the success of MIS increases with the use of DOSI and IGP in large lesions, the success decreases with the prolongation of the accumulation time of the given dose.

Conclusion: In the intraoperative gamma probe technique used in primary hyperparathyroidism patients, the method used with low-dose radioactive material has lower sensitivity but higher specificity in estimating the post-operative pathology compared to the high-dose technique.

Keywords: Hyperparathyroidism, Parathyroid adenoma, Gamma probe, Sestamibi, Radioactive material, Lesions.

[1]
Norman J, Politz D. Prospective study in 3000 consecutive parathyroid operations demonstrates 18 objective factors that influence the decision for unilateral versus bilateral approach. American Coll Surg 2010; 211(2): 244-9.
[2]
Bilezikian JP, Khan AA, Silverberg SJ, et al. Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop. J Bone Miner Res 2022; 37(11): 2293-314.
[http://dx.doi.org/10.1002/jbmr.4677] [PMID: 36245251]
[3]
Garimella V, Yeluri S, Alabi A, Samy AK. Minimally invasive video-assisted parathyroidectomy is a safe procedure to treat primary hyperparathyroidism. Surgeon 2012; 10(4): 202-5.
[4]
Sullivan DP, Scharf SC, Komisar A. Intraoperative gamma probe localization of parathyroid adenomas. Laryngoscope 2001; 111(5): 912-7.
[http://dx.doi.org/10.1097/00005537-200105000-00030] [PMID: 11359177]
[5]
Varoğlu E, Bayraktar R, Argon M, Atasever T, Çelen YZ. Parathyroid Scintigraphy Application Guideline. Turk J Nucl Med 2001; 10 (Suppl.): 35-9.
[6]
Desiato V, Melis M, Amato B, et al. Minimally invasive radioguided parathyroid surgery: A literature review. Int J Surg 2016; 28 (Suppl. 1): S84-93.
[http://dx.doi.org/10.1016/j.ijsu.2015.12.037] [PMID: 26721192]
[7]
Chien D, Jacene H. Imaging of parathyroid glands. Otolaryngol Clin North Am 2010; 43(2): 399-415.
[http://dx.doi.org/10.1016/j.otc.2010.01.008] [PMID: 20510723]
[8]
Gencoğlu EA, Aktaş A. The efficacy of low and high dose (99m)Tc-MIBI protocols for intraoperative identification of hyperplastic parathyroid glands in secondary hyperparathyroidism. Rev Esp Med Nucl Imagen Mol 2014; 33(4): 210-4.
[PMID: 24703993]
[9]
Melton LJ III. Epidemiology of primary hyperparathyroidism. J Bone Miner Res 1991; 6(S2) (Suppl. 2): S25-30.
[http://dx.doi.org/10.1002/jbmr.5650061409] [PMID: 1763669]
[10]
Heath H III, Hodgson SF, Kennedy MA. Primary Hyperparathyroidism. N Engl J Med 1980; 302(4): 189-93.
[http://dx.doi.org/10.1056/NEJM198001243020402] [PMID: 7350459]
[11]
Ljunghall S, Per Hellman , Rastad J, Åkerström G. Primary hyperparathyroidism: Epidemiology, diagnosis and clinical picture. World J Surg 1991; 15(6): 681-7.
[http://dx.doi.org/10.1007/BF01665300] [PMID: 1767533]
[12]
Auguste LJ, Attie JN, Schnaap D. Initial failure of surgical exploration in patients with primary hyperparathyroidism. Am J Surg 1990; 160(4): 333-6.
[http://dx.doi.org/10.1016/S0002-9610(05)80536-7] [PMID: 2221229]
[13]
van Heerden JA, Grant CS. Surgical treatment of primary hyperparathyroidism: An institutional perspective. World J Surg 1991; 15(6): 688-92.
[http://dx.doi.org/10.1007/BF01665301] [PMID: 1767534]
[14]
Denham DW, Norman J. Cost-effectiveness of preoperative sestamibi scan for primary hyperparathyroidism is dependent solely upon the surgeon’s choice of operative procedure. J Am Coll Surg 1998; 186(3): 293-305.
[http://dx.doi.org/10.1016/S1072-7515(98)00016-7] [PMID: 9510260]
[15]
Miller DL. Pre-Operative localization and interventional treatment of parathyroid tumors: When and how? World J Surg 1991; 15(6): 706-15.
[http://dx.doi.org/10.1007/BF01665304] [PMID: 1767536]
[16]
Melloul M, Paz A, Koren R, Cytron S, Feinmesser R, Gal R. 99mTc-MIBI scintigraphy of parathyroid adenomas and its relation to tumour size and oxyphil cell abundance. Eur J Nucl Med 2001; 28(2): 209-13.
[http://dx.doi.org/10.1007/s002590000406] [PMID: 11303892]
[17]
Falke THM, Sandler MP, Schipper J. Parathyroid glands. In: Sandler MP, Coleman RE, Eds. Diagnostic Nuclear Medicine. (3rd ed.). Baltimore, MD: Willams& Wilkins 1994; pp. 991-1012.
[18]
Civelek AC, Ozalp E, Donovan P, Udelsman R. Prospective evaluation of delayed technetium-99m sestamibi SPECT scintigraphy for preoperative localization of primary hyperparathyroidism. Surgery 2002; 131(2): 149-57.
[http://dx.doi.org/10.1067/msy.2002.119817] [PMID: 11854692]
[19]
Lavely WC, Goetze S, Friedman KP, 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(7): 1084-9.
[http://dx.doi.org/10.2967/jnumed.107.040428] [PMID: 17574983]
[20]
Moka D, Voth E, Dietlein M, Larena-Avellaneda A, Schicha H. Technetium 99m-MIBI-SPECT: A highly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery 2000; 128(1): 29-35.
[http://dx.doi.org/10.1067/msy.2000.107066] [PMID: 10876182]
[21]
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(3): 359-72.
[http://dx.doi.org/10.1016/j.otohns.2004.10.005] [PMID: 15746845]
[22]
Loftus KA, Anderson S, Mulloy AL, Terris DJ. Value of sestamibi scans in tertiary hyperparathyroidism. Laryngoscope 2007; 117(12): 2135-8.
[http://dx.doi.org/10.1097/MLG.0b013e31813e602a] [PMID: 17891049]
[23]
Lorberboym M, Minski I, Macadziob S, Nikolov G, Schachter P. Incremental diagnostic value of preoperative 99mTc-MIBI SPECT in patients with a parathyroid adenoma. J Nucl Med 2003; 44(6): 904-8.
[PMID: 12791817]
[24]
Sharma J, Mazzaglia P, Milas M, et al. Radionuclide imaging for hyperparathyroidism (HPT): Which is the best technetium-99m sestamibi modality? Surgery 2006; 140(6): 856-65.
[http://dx.doi.org/10.1016/j.surg.2006.07.031] [PMID: 17188131]
[25]
Geatti O, Shapiro B, Orsolon P, et al. Localization of parathyroid enlargement: experience with technetium-99m methoxyisobutylisonitrile and thallium-201 scintigraphy, ultrasonography and computed tomography. Eur J Nucl Med 1994; 21(1): 17-22.
[http://dx.doi.org/10.1007/BF00182301] [PMID: 8088281]
[26]
Harris L, Yoo J, Driedger A, et al. Accuracy of technetium-99m SPECT-CT hybrid images in predicting the precise intraoperative anatomical location of parathyroid adenomas. Head Neck 2008; 30(4): 509-17.
[http://dx.doi.org/10.1002/hed.20727] [PMID: 18059012]
[27]
Gough I. Reoperative parathyroid surgery: the importance of ectopic location and multigland disease. ANZ J Surg 2006; 76(12): 1048-50.
[http://dx.doi.org/10.1111/j.1445-2197.2006.03931.x] [PMID: 17199687]
[28]
Bozkurt MF, Uğur O, Hamaloğlu E, Sayek I, Gulec SA. Optimization of the gamma probe-guided parathyroidectomy. Am Surg 2003; 69(8): 720-5.
[http://dx.doi.org/10.1177/000313480306900815] [PMID: 12953832]
[29]
Rubello D, Giannini S, Martini C, et al. Minimally invasive radioguided parathyroidectomy. Biomed Pharmacother 2006; 60(3): 134-8.
[http://dx.doi.org/10.1016/j.biopha.2006.01.006] [PMID: 16524690]
[30]
Rubello D, Pelizzo MR, Boni G, et al. Radioguided surgery of primary hyperparathyroidism using the low-dose 99mTc-sestamibi protocol: multi-institutional Imaging of Parathyroid Glands 413 experience from the Italian Study Group on Radioguided Surgery and Immunoscintigraphy (GISCRIS). J Nucl Med 2005; 46(2): 220-6.
[PMID: 15695779]
[31]
Tublin ME, Pryma DA, Yim JH, et al. Localization of parathyroid adenomas by sonography and technetium tc 99m sestamibi single-photon emission computed tomography before minimally invasive parathyroidectomy: are both studies really needed? J Ultrasound Med 2009; 28(2): 183-90.
[http://dx.doi.org/10.7863/jum.2009.28.2.183] [PMID: 19168768]
[32]
Sukan A, Reyhan M, Aydin M, et al. Preoperative evaluation of hyperparathyroidism: the role of dual-phase parathyroid scintigraphy and ultrasound imaging. Ann Nucl Med 2008; 22(2): 123-31.
[http://dx.doi.org/10.1007/s12149-007-0086-z] [PMID: 18311537]
[33]
Lopez Hänninen E, Steinmüller T, Rohlfing T, et al. Preoperative localization of parathyroid glands. Nucl Med (Stuttg) 2004; 43(3): 85-90.
[http://dx.doi.org/10.1055/s-0038-1625596] [PMID: 15201949]
[34]
Uludağ M. Preoperative Localization Studies in Primary Hyperparathyroidism Med Bull Sisli Etfal Hosp 2019; 53: 7-15.
[35]
Bunch PM, Kelly HR. Preoperative Imaging Techniques in Primary Hyperparathyroidism. JAMA Otolaryngol Head Neck Surg 2018; 144(10): 929-37.
[http://dx.doi.org/10.1001/jamaoto.2018.1671] [PMID: 30193297]
[36]
Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surg 2016; 151(10): 959-68.
[http://dx.doi.org/10.1001/jamasurg.2016.2310] [PMID: 27532368]
[37]
Patel SG, Saunders ND, Jamshed S, Weber CJ, Sharma J. Multimodal preoperative localization improves outcomes in reoperative parathyroidectomy: A 25-Year surgical experience. Am Surg 2019; 85(9): 939-43.
[http://dx.doi.org/10.1177/000313481908500932] [PMID: 31638503]
[38]
Unlu MT, Aygun N, Akgun IE, et al. Parathyroidectomy results in primary hyperparathyroidism: analysis of the results from a single center. Sisli Etfal Hastan Tip Bult 2021; 55(2): 173-8.
[http://dx.doi.org/10.14744/SEMB.2021.72681] [PMID: 34349592]
[39]
Goldfarb M, Singer FR. Recent advances in the understanding and management of primary hyperparathyroidism. F1000 Res 2020; 9: 143.
[http://dx.doi.org/10.12688/f1000research.21569.1] [PMID: 32148764]
[40]
Mainali B, Lindeman B, Chen H. Re-operative Parathyroidectomy in Patients With Mild Primary Hyperparathyroidism. J Surg Res 2020; 255: 130-4.
[http://dx.doi.org/10.1016/j.jss.2020.05.043] [PMID: 32543378]
[41]
Di Marco A, Mechera R, Glover A, et al. Focused parathyroidectomy without intraoperative parathyroid hormone measurement in primary hyperparathyroidism: Still a valid approach? Surgery 2021; 170(5): 1383-8.
[http://dx.doi.org/10.1016/j.surg.2021.05.030] [PMID: 34144815]

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