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Vol. 69. Issue 2.
Pages 86-94 (March - April 2018)
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Vol. 69. Issue 2.
Pages 86-94 (March - April 2018)
Original article
Radioguided Surgery in Primary Hyperparathyroidism: Results and Correlation With Intraoperative Histopathologic Diagnosis
Cirugía radioguiada en el hiperparatiroidismo primario: resultados y correlación con el diagnóstico anatomopatológico intraoperatorio
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Juan P. Suáreza,
Corresponding author
juanpablosuarez@yahoo.es

Corresponding author.
, María L. Domínguezb, Francisco J. de Santosc, José M. Gonzálezc, Nuria Fernándezd, Fidel J. Encisoe
a Servicio de Medicina Nuclear, Hospital San Pedro de Alcántara, Cáceres, Spain
b Servicio de Medicina Nuclear, Hospital Universitario Central de Asturias, Oviedo, Spain
c Unidad de Cirugía Endocrina, Servicio de Cirugía General, Hospital San Pedro de Alcántara, Cáceres, Spain
d Servicio de Anatomía Patológica, Hospital San Pedro de Alcántara, Cáceres, Spain
e Servicio de Endocrinología, Hospital San Pedro de Alcántara, Cáceres, Spain
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Figures (2)
Tables (4)
Table 1. Results of Histopathologic Analysis of the Resected Specimens.
Table 2. Results of the Gamma Detector Probe Compared With the Histopathologic Analysis in Resected Specimens.
Table 3. Results per Patient and Follow-up Data.
Table 4. Summary of the Outcomes Obtained in Different Studies of Radio Guided Surgery Used in Hyperparathyroidism.
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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:
Primary hyperparathyroidism
Radioguided surgery
Parathyroid neoplasms
Technetium Tc-99m sestamibi
Minimally invasive surgical procedures
Gamma probe
Resumen
Introducción y objetivos

La cirugía radioguiada es una técnica de tratamiento quirúrgico mínimamente invasivo del hiperparatiroidismo primario. Los objetivos de este estudio fueron estudiar el porcentaje de éxito de esta técnica y realizar una comparación de la misma con el estudio histológico intraoperatorio.

Métodos

Estudiamos retrospectivamente a 84 pacientes con hiperparatirodismo primario con gammagrafía paratiroidea positiva. Se administró una dosis de Tc-99m sestamibi previa a la cirugía y se utilizó una sonda gammadetectora intraoperatoria para detectar el tejido paratiroideo anómalo, siguiendo la «regla del 20%». En todos los casos se realizó estudio anatomopatológico intraoperatorio y seguimiento clínico y analítico durante al menos 6 meses. Asimismo, se comparó el valor predictivo positivo de la ecografía cervical respecto a la gammagrafía paratiroidea.

Resultados

El porcentaje de éxito de la cirugía radioguiada fue 99%. La sonda gammadetectora intraoperatoria tuvo una sensibilidad, especificidad, valores predictivos positivo y negativo respecto al estudio histológico intraoperatorio de 99, 73, 97 y 89%, respectivamente. La calcemia se normalizó en 83 de 84 pacientes (99%) y la paratohormona se normalizó en 77 de los 84 pacientes (92%). La ecografía mostró un bajo valor predictivo positivo (41%) comparada con la gammagrafía.

Conclusiones

La cirugía radioguiada es una técnica con excelentes resultados en el tratamiento quirúrgico mínimamente invasivo del hiperparatiroidismo primario y podría sustituir tanto al estudio anatomopatológico intraoperatorio como a la determinación intraoperatoria de paratohormona. Esta última posibilidad debe ser demostrada en futuros estudios.

Palabras clave:
Hiperparatiroidismo primario
Cirugía radiodirigida
Neoplasias paratiroideas
Tecnecio Tc-99m sestamibi
Técnicas de cirugía mínimamente invasiva
Sonda gammadetectora

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