Role of gamma probes in performing minimally invasive parathyroidectomy in patients with primary hyperparathyroidism: optimization of preoperative and intraoperative procedures.

Objective: In the last decade, surgery of primary hyperparathyroidism (HPT) due to a solitary adenoma has moved on from the traditional wide bilateral neck exploration (BNE) to more limited approaches such as unilateral neck exploration and minimally invasive parathyroidectomy.

Design: To define the role of intraoperative gamma probe and injection of a low (99m)Tc-MIBI dose in performing minimally invasive radio-guided surgery (MIRS) in HPT patients with a solitary parathyroid adenoma.

Methods: From September 1999 to July 2002, 214 patients with primary HPT entered the study.

Optimization of peroperative procedures.

Minimally invasive radio-guided surgery (MIRS) of parathyroid adenomas has been favoured by three main factors. One is the significant improvements achieved in preoperative localizing imaging, particularly with sestamibi scintigraphy. Another is the availability of intra-operative quick parathyroid hormone measurement, and finally the increase in availability of the intra-operative gamma probes in many surgical centres especially those performing sentinel node biopsy.

Determinant role of Tc-99m MIBI SPECT in the localization of a retrotracheal parathyroid adenoma successfully treated by radioguided surgery.

Purpose: The authors' aim was to evaluate the role of MIBI SPECT acquired just after planar pertechnetate-MIBI (TcO(4)-MIBI) subtraction scintigraphy in planning radioguided surgery in a patient with persistent primary hyperparathyroidism after initial surgery performed to treat a retrotracheal parathyroid adenoma (PA).

Methods: A 73-year-old man with persistent primary hyperparathyroidism after a previous left parathyroidectomy and left thyroid lobectomy is described. The patient was examined in our center in a single-day preoperative imaging protocol based on findings of planar TcO(4)-MIBI subtraction scintigraphy, MIBI SPECT, high-resolution neck ultrasound, and computed tomography.

Nuclear medicine imaging procedures in differentiated thyroid carcinoma patients with negative iodine scan.

Radioiodine treatment following surgery is an effective therapy in differentiated thyroid carcinoma (DTC) patients. However, in DTC patients with metastases characterized by very low or absent iodine uptake, total thyroidectomy and radical loco-regional lymphoadenectomy is the only effective therapeutic approach. In the present article, we have discussed the most recently available nuclear medicine techniques utilized for the detection of DTC metastases that have lost the capacity to trap radioiodine.