Radioguided surgery in primary hyperparathyroidism: Results and correlation with intraoperative histopathologic diagnosis

Abstract

Introduction and objectives: Radioguided surgery is a minimally invasive surgical technique for the treatment of primary hyperparathyroidism. The goals of our study were to evaluate the rate of success and compare the results with intraoperative histological analysis.

Methods: We retrospectively studied 84 patients with primary parathyroidism who had undergone radioguided surgery. All the patients had a positive parathyroid scintigraphy prior to surgery. An intravenous injection of Tc-99m sestamibi was administered before surgery, and radioguided location of the pathologic parathyroid tissue was performed using an intraoperative gamma probe, applying the "20% rule". All resected specimens underwent intraoperative histologic analysis. All patients were followed up for at least 6 months. Positive predictive values of both parathyroid scintigraphy and cervical ultrasonography were also compared.

Results: Radioguided surgery success rate was 99%. Sensitivity, specificity, positive and negative predictive values for gamma probe were 99, 73, 97 and 89%, respectively. After surgery, 83 of 84 patients were eucalcaemic (99%) and parathyroid hormone normalised in 77 of 84 patients (92%). Ultrasonography showed low positive predictive value (41%) when compared with scintigraphy.

Conclusions: Radioguided surgery is a minimally invasive surgical technique with excellent results for the treatment of primary hyperparathyroidism and could replace both intraoperative histological analysis and intraoperative parathyroid hormone assay. Further studies are needed to confirm these findings.

Keywords: Cirugía radiodirigida; Gamma probe; Hiperparatiroidismo primario; Minimally invasive surgical procedures; Neoplasias paratiroideas; Parathyroid neoplasms; Primary hyperparathyroidism; Radioguided surgery; Sonda gammadetectora; Technetium Tc-99m sestamibi; Tecnecio Tc-99m sestamibi; Técnicas de cirugía mínimamente invasiva.