MIRS Protocol of the Present Study
| Step | Description |
|---|---|
| A | Antecubital venous blood sampling both before surgery and 10 min after PA removal, for IQPTH. |
| B | Intravenous injection of 99mTc-sestamibi (37–110 MBq, or 1–3 mCi: 37 MBq in 79% of patients, 74 MBq in 13%, and 110 MBq in 8%) in operating theater 10–30 min before surgery. |
| C | Before surgical incision, external γ-probe scanning to identify area with maximum count activity (cutaneous projection of PA). |
| D | Surgical access either in midline of neck (approximately 1 cm above sternal notch) or in lateral neck (anterior border of sternocleidomastoid muscle), depending on each surgeon’s experience and convenience. |
| E | Repeated insertion of γ-probe through a 2- to 2.5-cm skin incision, guiding surgeon to area with maximum count activity, corresponding to PA (ligature of middle thyroid vein and inferior thyroid artery was necessary in some patients with PA deep in neck). |
| F | γ-Probe measurement of radioactivity count rate on PA, thyroid gland, and background. |
| G | γ-Probe measurement of radioactivity count rate on ex vivo PA to evaluate success of parathyroid tissue removal. |
| H | γ-Probe scanning of surgical bed to evaluate completeness of parathyroid tissue removal. |
| I | Calculation of γ-probe count-rate ratios for various tissues. |