Utility of an intraoperative gamma probe in the surgical management of secondary or tertiary hyperparathyroidism

Jorna, Francisca H.; Jager, Pieter L.; Lemstra, Clara; Wiggers, Theo; Stegeman, Coen A.; Plukker, John T.M.

doi:10.1016/j.amjsurg.2007.05.059

« Previous Next »The American Journal of Surgery
Volume 196, Issue 1 , Pages 13-18, July 2008

Utility of an intraoperative gamma probe in the surgical management of secondary or tertiary hyperparathyroidism

Francisca H. Jorna, M.D.
- Department of Surgery/Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Pieter L. Jager, M.D., Ph.D.
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Clara Lemstra
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Theo Wiggers, M.D., Ph.D.
- Department of Surgery/Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Coen A. Stegeman, M.D., Ph.D.
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
John T.M. Plukker, M.D., Ph.D.
- Department of Surgery/Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Corresponding author. Tel.: +0031-50-3612317; fax: +0031-50-3614873.

Received 5 March 2007; received in revised form 23 May 2007 published online 24 April 2008.

Abstract

Background

In primary hyperparathyroidism the gamma probe is effective, but its role in secondary hyperparathyroidism is unclear. We investigated the utility of the probe in the surgical management of secondary and tertiary hyperparathyroidism.

Methods

The value of the probe in guiding resection of parathyroids was determined prospectively in 29 patients with secondary or tertiary hyperparathyroidism. Resected tissues with radioactivity of greater than 20% as compared with the wound bed was considered hyperfunctional parathyroid and was confirmed histologically.

Results

The probe was helpful in guiding resection in 13% of the hyperplastic glands, including ectopic glands and those not detected preoperatively. The gamma probe confirmed the presence of hyperfunctional parathyroid after resection with a sensitivity and specificity of 97% and 92%, respectively.

Conclusions

The probe is particularly useful in confirming the presence of hyperfunctional parathyroids after resection. It also is useful in identifying ectopic localizations, but its value is limited in guiding surgery for secondary or tertiary disease.

Keywords: Parathyroidectomy, Secondary hyperparathyroidism, Gamma probe, ^99mTc-sestamibi