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Panminerva Medica 2002 June;44(2):99-105

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Recent advances in preoperative and intraoperative nuclear medicine procedures in patients with primary hyperparathyroidism

Rubello D., Casara D., Shapiro B.

From the Nuclear Medicine Service Department of Radiotherapy General Hospital of Padova, Padova, Italy *Division of Nuclear Medicine Department of Radiology Michigan University Medical Center, Ann Arbor, Michigan, USA


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Although bilat­er­al ­neck explo­ra­tion is tra­di­tion­al­ly con­sid­ered as the treat­ment of ­choice in ­patients ­with pri­mary hyper­pa­rath­yr­oi­dism (HPT), sev­er­al sur­gi­cal tech­niques of lim­it­ed ­neck explo­ra­tion ­have ­been pro­posed ­over the ­last 10 ­years in pri­mary HPT ­patients ­with a ­high prob­abil­ity to be affect­ed by a sol­i­tary para­thy­roid aden­o­ma. The avail­abil­ity in ­recent ­years of ­highly sen­si­tive and accu­rate pre­op­er­a­tive imag­ing modal­ities, par­tic­u­lar­ly the para­thy­roid scin­tig­ra­phy ­with 99mTc-­MIBI and ­high res­o­lu­tion ­neck ultra­so­nog­ra­phy, ­allowed to ­increase the ­rate of pri­mary HPT ­patients as can­di­dates to a selec­tive par­a­thy­roi­dec­to­my. One of the ­most inno­va­tive tech­niques for lim­it­ed sur­gery is the min­i­mal­ly inva­sive ­radio-guid­ed par­a­thy­roi­dec­to­my ­that is ­based on the intra­op­er­a­tive detec­tion of the para­thy­roid aden­o­ma ­under the guid­ance of a gamma ­probe allow­ing the remov­al of the para­thy­roid aden­o­ma ­through a ­small 2-cm ­skin inci­sion. However, if a min­i­mal­ly inva­sive par­a­thy­roi­dec­to­my is tak­en ­into con­sid­er­a­tion, accu­rate pre­op­er­a­tive imag­ing is man­da­to­ry not ­only to dis­tin­guish ­patients ­with a sol­i­tary para­thy­roid aden­o­ma ­from ­those ­with mul­ti-glan­du­lar dis­ease but ­also to diag­nose ­patients ­with con­com­i­tant thy­roid nod­ule(s) ­that can ­cause ­false-pos­i­tive ­results at ­radio-guid­ed sur­gery. In the ­present ­study the ­most ­recent advanc­es ­reached ­with pre­op­er­a­tive local­iz­ing imag­ing of para­thy­roid aden­o­mas are ­reviewed and the tech­niques pro­posed to per­form a min­i­mal­ly inva­sive ­radio-guid­ed sur­gery are dis­cussed ­with par­tic­u­lar ­regard to the ther­a­peu­tic effi­ca­cy and ­cost-effec­tive­ness anal­y­sis.

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