Relative contributions of technetium Tc 99m sestamibi scintigraphy, intraoperative gamma probe detection, and the rapid parathyroid hormone assay to the surgical management of hyperparathyroidism

Alan P B Dackiw, Jeffrey J. Sussman, Herbert A. Fritsche, Ebrahim S. Delpassand, Pam Stanford, Ana Hoff, Robert F. Gagel, Douglas B. Evans, Jeffrey E. Lee

Research output: Contribution to journalArticle

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Abstract

Hypothesis: Technetium Tc 99m sestamibi scintigraphy, intraoperative gamma probe detection, and the rapid parathyroid hormone assay have been used to permit a directed operation in patients with hyperparathyroidism. We hypothesized that the coordinated use of these techniques might be particularly useful in patients who require a second operation for hyperparathyroidism. Design: Retrospective analysis was performed to determine the specific contribution of these technologies to the surgical management of patients with hyperparathyroidism who underwent evaluation by at least 2 of these techniques between April 1996 and October 1999. Setting: Patients were evaluated and treated by an endocrine tumor surgery group within a tertiary care referral center. Patients: Coordinated application of 99mTc-sestamibi scintigraphy, intraoperative gamma probe detection, and/or the rapid parathyroid hormone assay was performed in 32 patients. Results: Twenty-eight of 32 patients had primary hyperparathyroidism, 3 had multiple endocrine neoplasia type 1, and 1 had secondary hyperparathyroidism. The surgical procedure was an initial cervical exploration in 19 and a second operative procedure in 13. Parathyroidectomy was successful in all patients. A directed anatomic operation was performed in 24 patients, including 11 patients who underwent second operative procedures and 9 patients who underwent minimally invasive procedures under local anesthesia. A directed operation was facilitated by sestamibi scan in 22 of 24 patients, intraoperative gamma probe detection in 5 of 23 patients, and the rapid parathyroid hormone assay in 15 of 15 patients. Conclusions: Coordinated application of 99mTc-sestamibi scintigraphy, intraoperative gamma probe detection, and the rapid parathyroid hormone assay allows for successful directed reoperative parathyroidectomy; a minimally invasive procedure may be performed in selected patients.

Original languageEnglish (US)
Pages (from-to)550-557
Number of pages8
JournalArchives of Surgery
Volume135
Issue number5
StatePublished - May 2000

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Technetium Tc 99m Sestamibi
Hyperparathyroidism
Parathyroid Hormone
Radionuclide Imaging
Parathyroidectomy
Operative Surgical Procedures
Tertiary Care Centers
Multiple Endocrine Neoplasia Type 1
Secondary Hyperparathyroidism
Primary Hyperparathyroidism
Local Anesthesia

ASJC Scopus subject areas

  • Surgery

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Relative contributions of technetium Tc 99m sestamibi scintigraphy, intraoperative gamma probe detection, and the rapid parathyroid hormone assay to the surgical management of hyperparathyroidism. / Dackiw, Alan P B; Sussman, Jeffrey J.; Fritsche, Herbert A.; Delpassand, Ebrahim S.; Stanford, Pam; Hoff, Ana; Gagel, Robert F.; Evans, Douglas B.; Lee, Jeffrey E.

In: Archives of Surgery, Vol. 135, No. 5, 05.2000, p. 550-557.

Research output: Contribution to journalArticle

Dackiw, Alan P B ; Sussman, Jeffrey J. ; Fritsche, Herbert A. ; Delpassand, Ebrahim S. ; Stanford, Pam ; Hoff, Ana ; Gagel, Robert F. ; Evans, Douglas B. ; Lee, Jeffrey E. / Relative contributions of technetium Tc 99m sestamibi scintigraphy, intraoperative gamma probe detection, and the rapid parathyroid hormone assay to the surgical management of hyperparathyroidism. In: Archives of Surgery. 2000 ; Vol. 135, No. 5. pp. 550-557.
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abstract = "Hypothesis: Technetium Tc 99m sestamibi scintigraphy, intraoperative gamma probe detection, and the rapid parathyroid hormone assay have been used to permit a directed operation in patients with hyperparathyroidism. We hypothesized that the coordinated use of these techniques might be particularly useful in patients who require a second operation for hyperparathyroidism. Design: Retrospective analysis was performed to determine the specific contribution of these technologies to the surgical management of patients with hyperparathyroidism who underwent evaluation by at least 2 of these techniques between April 1996 and October 1999. Setting: Patients were evaluated and treated by an endocrine tumor surgery group within a tertiary care referral center. Patients: Coordinated application of 99mTc-sestamibi scintigraphy, intraoperative gamma probe detection, and/or the rapid parathyroid hormone assay was performed in 32 patients. Results: Twenty-eight of 32 patients had primary hyperparathyroidism, 3 had multiple endocrine neoplasia type 1, and 1 had secondary hyperparathyroidism. The surgical procedure was an initial cervical exploration in 19 and a second operative procedure in 13. Parathyroidectomy was successful in all patients. A directed anatomic operation was performed in 24 patients, including 11 patients who underwent second operative procedures and 9 patients who underwent minimally invasive procedures under local anesthesia. A directed operation was facilitated by sestamibi scan in 22 of 24 patients, intraoperative gamma probe detection in 5 of 23 patients, and the rapid parathyroid hormone assay in 15 of 15 patients. Conclusions: Coordinated application of 99mTc-sestamibi scintigraphy, intraoperative gamma probe detection, and the rapid parathyroid hormone assay allows for successful directed reoperative parathyroidectomy; a minimally invasive procedure may be performed in selected patients.",
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AU - Sussman, Jeffrey J.

AU - Fritsche, Herbert A.

AU - Delpassand, Ebrahim S.

AU - Stanford, Pam

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AU - Gagel, Robert F.

AU - Evans, Douglas B.

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