PT  - JOURNAL ARTICLE
AU  - Domenico Rubello
AU  - Maria Rosa Pelizzo
AU  - Giuseppe Boni
AU  - Riccardo Schiavo
AU  - Luca Vaggelli
AU  - Giuseppe Villa
AU  - Sergio Sandrucci
AU  - Andrea Piotto
AU  - Gianpiero Manca
AU  - Pierluigi Marini
AU  - Giuliano Mariani
TI  - Radioguided Surgery of Primary Hyperparathyroidism Using the Low-Dose <sup>99m</sup>Tc-Sestamibi Protocol: Multiinstitutional Experience from the Italian Study Group on Radioguided Surgery and Immunoscintigraphy (GISCRIS)
DP  - 2005 Feb 01
TA  - Journal of Nuclear Medicine
PG  - 220--226
VI  - 46
IP  - 2
4099  - http://jnm.snmjournals.org/content/46/2/220.short
4100  - http://jnm.snmjournals.org/content/46/2/220.full
SO  - J Nucl Med2005 Feb 01; 46
AB  - This study evaluated the accuracy of 99mTc-sestamibi scintigraphy and neck ultrasonography in patients with primary hyperparathyroidism (PHPT) and the role of intraoperative hand-held γ-probes in minimally invasive radioguided surgery (MIRS) of patients with a high likelihood of a solitary parathyroid adenoma (PA). The study was undertaken under the aegis of the Italian Study Group on Radioguided Surgery and Immunoscintigraphy (GISCRIS). Methods: Clinical records were reviewed for 384 consecutive PHPT patients undergoing radioguided surgery using a low dose of 99mTc-sestamibi. Selection of patients for MIRS instead of traditional bilateral neck exploration was based on preoperative imaging indicating a solitary PA. 99mTc-Sestamibi (37–110 MBq, or 1–3 mCi) was injected in the operating theater 10–30 min before the start of the intervention. Either 11-mm collimated (309 patients) or 14-mm collimated (75 patients) γ-probes were used. Intraoperative quick parathyroid hormone (IQPTH) assay was used on 308 patients (80.2%). Results: MIRS was successfully performed on 268 (96.8%) of 277 patients. Conversion to bilateral neck exploration was necessary in 9 patients (3.3%) because of either persistently high IQPTH levels after removal of the preoperatively visualized PA (4 patients), intraoperative frozen-section diagnosis of parathyroid carcinoma (2 patients), or hard-to-remove PA (3 patients). MIRS, which was performed under locoregional anesthesia in 72 patients, required a mean operating time of 37 min and a mean hospital stay of 1.2 d. MIRS was successfully performed also on 32 (78.0%) of 41 patients who had previously undergone thyroid or parathyroid surgery. No major surgical complications were observed in the MIRS group, and there were only 24 cases (11%) of transient postoperative hypocalcemia. The probe was of little help in patients with concomitant 99mTc-sestamibi–avid thyroid nodules and not helpful at all in patients with negative scan findings preoperatively. IQPTH measurement helped to disclose some cases of multigland parathyroid disease. Conclusion: 99mTc-Sestamibi scintigraphy, especially if combined with neck ultrasonography, is highly accurate in selecting PHPT candidates for MIRS. The low-dose 99mTc-sestamibi protocol (which entails a low-to-negligible radiation exposure to the surgical team) is safe and effective for MIRS. MIRS plays a limited role in patients with concomitant 99mTc-sestamibi–avid thyroid nodules and should be discouraged in patients with negative 99mTc-sestamibi finding preoperatively. IQPTH can be recommended during MIRS to facilitate intraoperative identification of previously undiagnosed multigland parathyroid disease.