American Association of Endocrine SurgeonsThe 20% rule: A simple, instantaneous radioactivity measurement defines cure and allows elimination of frozen sections and hormone assays during parathyroidectomy☆
Section snippets
Patients
Between February 1997 and March 1999, 345 consecutive patients referred to the University of South Florida with primary sporadic HPT were entered into a prospective protocol. All underwent a parathyroidectomy while they were radioactive, after a systemic injection of 99Tc-labeled sestamibi. Patients with secondary hyperparathyroidism and those with familial forms of this disease were not included.
Sestamibi scanning
All patients were injected with 20- to 25-mCu 99Tc sestamibi between 1.5 and 3.5 hours prior to
Outcome and follow-up
With 100% follow-up (mean, 10.8 months; range 2-24 months), 342 (99.5%) patients had normal serum calcium and parathyroid hormone levels, including all 300 undergoing a MIRP.
Comparisons of radioactive ratios with permanent histology
Comparisons of radioactive ratios with tissue histology and follow-up postoperative laboratory values showed that fat, lymph nodes, and normal parathyroids never contained more than 2.2% of background radioactivity (Table). Normal thyroid tissue and hyperplastic parathyroid glands contained slightly more radioactivity
Discussion
HPT is a physiologic disease based on cellular hyperfunction with its attendant parathyroid hormone overproduction within 1 or more parathyroid glands. Until very recently, surgeons have treated this disease and concluded the operation by surgically removing enlarged or even normal-sized glands based purely on how they look to the naked or magnified eye. This has led to the common practice of performing multiple frozen sections during the course of a parathyroid operation, even when the surgeon
References (23)
- et al.
Minimally invasive parathyroidectomy facilitated by intraoperative nuclear mapping
Surgery
(1997) - et al.
Minimally invasive radioguided parathyroidectomy in the reoperative neck
Surgery
(1998) - et al.
Persistent and recurrent hyperparathyroidism
Am J Surg
(1981) - et al.
Identification of histologically undetectable parathyroid hyperplasia by flow cytometry
Am J Surg
(1979) - et al.
Intraoperative parathyroid hormone monitoring as an adjunct to parathyroidectomy
Surgery
(1996) - et al.
Operative monitoring of parathyroid gland hyperfunction
Am J Surg
(1991) - et al.
A new, practical intraoperative parathyroid hormone assay
Am J Surg
(1994) - et al.
Primary hyperparathyroidism in the 1990s: choice of surgical procedures for this disease
Ann Surg
(1992) - et al.
Intraoperative confirmation of parathyroid tissue during parathyroid exploration
Am J Surg Path
(1998) - et al.
The reasons for failure in parathyroid operations
Arch Surg
(1989)
Parathyroid hormone: before and after parathyroidectomy
Surgery
Cited by (0)
- ☆
James Norman, MD, University of South Florida, Department of Surgery, P.O. Box 1289, Tampa General Hospital, Tampa, FL 33601.