Radioguided parathyroidectomy: How does it contribute to surgery?

Objective: To evaluate whether a radioguided approach allows a higher intraoperative detection rate of adenoma and a minimally invasive parathyroidectomy (MIP), with the same or better cure rate of hyperparathyroidism secondary to parathyroid adenoma.

Methods: This was an observational, prospective, single-center study involving 254 consecutive patients with primary hyperparathyroidism, between 2017 and 2022. A total of 258 procedures were performed: 129 non radioguided (NRS) and 129 radioguided (RS) (112 with intravenous 99mTc- MIBI and 17 with ultrasound-guided intralesional 99mTc-MAA injection) with an intraoperative gamma probe and gamma camera. Follow-up was performed for at least one year.

Results: There were no differences between the groups in terms of age, sex, preoperative calcium or parathyroid hormone levels, adenoma localization with 99mTc-MIBI-gammagraphy and ultrasound, and surgical morbidity. Intraoperative surgical localization was 97.7% in both groups. Statistically significant differences supported RS: It allowed to perform MIP (RS: 96.9%, NRS 88.4%; p = 0.015), also in patients with previous neck surgery (RS: 75%, NRS: 28%; p = 0.019) and with ectopic adenomas (RS: 93.3%, NRS: 71.4%; p = 0.012). The operative time was significantly shorter (RS: 51 min, NRS: 59.79 min; p = 0.005). There were no significant differences in the postoperative complications between the groups. Biochemical cure at six months was achieved in RS: 97.7% and NRS: 93.8% (p = 0.12).

Conclusions: Radioguided MIP is useful in ectopic adenomas and in patients with previous cervical surgery and allows a minimally invasive approach more frequently. It is a safe surgery, easily reproducible by an endocrine surgeon and requires usual equipment found in operating rooms.