The role of gamma probe activity counts in minimally invasive parathyroidectomy

Summary

Aim: The benefit of preoperative gamma probe in the diagnosis of adenoma in patients with histopathologically proven parathyroid (PT) adenomas was examined. Patients, material, methods: 20 patients with positive ^99mTc MIBI uptake in PT scintigraphy with primary hyper-parathyroidism were enrolled in this study. 740 MBq ^99mTc MIBI were injected 3 h before operation. Counts of four PT regions were obtained with gamma probe before surgery in the operation room. All suspected PT adenomas were resected and histopathologically diagnosed as adenomas. We also obtained counts of the resection region and the resected adenoma with gamma probe after the parathyroidectomy. Preoperative counts of adenoma bearing regions (ABR), non-adenoma bearing regions (NABR), postoperative resection region (PRR), resected adenoma counts (RA) were registered. Statistical analysis was performed by Wilcoxon rank test. Results: The mean counts of ABR, NABR, the PRR and RA were 462 ± 106, 230 ± 66, 164 ± 42, 374 ± 87, respectively. The mean counts from ABR were twofold higher than those of NABR. The PRR mean counts decreased by 64% when compared to the mean counts of ABR and by 55% when compared to the mean counts of RA. The differences in mean counts of ABR and NABR, PRR and ABR, PRR and RA (p <0.01) turned out as statistically significant. Discussion: According to our preliminary results, the region with the highest counts is at least 2 ± 0,4 times higher than the mean of the other three PT regions. Thus, it seems to be significant for PT adenoma. Resection of adenoma may be accepted as successful, if the count of ABR decreased more than 64% with decreased postoperative parathormone levels. Conclusion: This technique should not yet be applied instead of parathormone measurement or frozen technique. But it may replace the frozen technique used for confirmation of the diagnosis during the operation in the future.

Zusammenfassung

Ziel: Der Vorteil der präoperativen Sondenmessung wurde im Rahmen der Adenomdiagnose histopathologisch nachgewiesenem Parathyroid(PT)-adenom untersucht. Patienten, Material, Methoden: An dieser Studie nahmen 20 Patienten mit primärem Hyperparathyroidismus teil, die einen positiven ^99mTc-MIBI-Uptake in der PT-Szintigraphie aufwiesen. Ihnen waren 740 MBq ^99mTc-MIBI vor der Operation injiziert worden. Vor dem chirurgischen Eingriff wurden Werte aus vier PT-Regionen mit Gammaprobe erhalten. Alle vermuteten PT-Adenome wurden entfernt und histopathologisch als Adenome diagnostiziert. Es wurden präoperative Werte aus adenomtragenden (ABR) und nicht adenomtragenden Regionen (NABR) sowie postoperativ Werte aus dem Resektionsgebiet (PRR) und dem entfernten Adenom (RA) registriert. Die statistische Analyse erfolgte nach Wilcoxon. Ergebnisse: Die Mittelwerte von ABR, NABR, PRR und RA waren 462 ± 106, 230 ± 66, 164 ± 42 und 374 ± 87. Die ABR-Mittelwerte waren doppelt so hoch wie die NABR-Mittelwerte. PRR-Werte waren im Mittel um 64% geringer als die ABR-Werte und um 55% geringer als die RA-Mittelwerte. Die Unterschiede in den Mittelwerten von ABR und NABR, PRR und ABR, PRR und RA (p <0,01) sind statistisch relevant. Diskussion: Nach unseren Ergebnissen ist die Region mit den höchsten Werten wenigstens um den Faktor 2 ± 0,4 höher als das Mittel der anderen drei PT-Regionen und scheint daher bedeutsam für PT-Adenome zu sein. Die Resektion von Adenomen kann als erfolgreich angenommen werden, wenn die ABR-Werte postoperativ um mehr als 64% abgenommen haben sowie die Parathormonkonzentration. Schlussfolgerung: Diese Technik sollte noch nicht anstelle der Parathormonbestimmung oder Histopathologie angewendet werden. Es könnte vielleicht zukünftig die histologische Sicherung der Diagnose ersetzen.

Keywords

Parathyroid adenoma - minimally invasive parathyroidectomy - ^99mTc MIBI - gamma probe activity counts

Schlüsselwörter

Parathyroidadenom - minimal invasive Parathyroidektomie - ^99mTc-MIBI - Messsonde

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