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

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 hypoth esized that the coordinated use of these techniques might be particularly u seful in patients who require a second operation for hyperparathyroidism. Design: Retrospective analysis was performed to determine the specific cont ribution of these technologies to the surgical management of patients with hyperparathyroidism who underwent evaluation by at least 2 of these techniq ues 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 Tc-99m-sestamibi scintigraphy, intraop erative gamma probe detection, and/or the rapid parathyroid hormone assay w as performed in 32 patients. Results: Twenty-eight of 32 patients had primary hyperparathyroidism, 3 had multiple endocrine neoplasia type 1, and 1 had secondary hyperparathyroidi sm. The surgical procedure was an initial cervical exploration in 19 and a second operative procedure in 13. Parathyroidectomy was successful in all p atients. A directed anatomic operation was performed in 24 patients, includ ing 11 patients who underwent second operative procedures and 9 patients wh o underwent minimally invasive procedures under local anesthesia. A directe d operation was facilitated by sestamibi scan in 22 of 24 patients, intraop erative gamma probe detection in 5 of 23 patients, and the rapid parathyroi d hormone assay in 15 of 15 patients. Conclusions: Coordinated application of Tc-99m-sestamibi scintigraphy, intr aoperative gamma probe detection, and the rapid parathyroid hormone assay a llows for successful directed reoperative parathyroidectomy; a minimally in vasive procedure may be performed in selected patients.