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

lingua: Inglese

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


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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