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
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Radio-guided procedure in minimally invasive surgery for primary hyperparathyroidism
2023, Cirugia EspanolaComparative utility of preoperative imaging in normocalcemic versus hypercalcemic primary hyperparathyroidism
2023, American Journal of SurgeryVitamin D deficiency is associated with single gland parathyroid disease
2022, American Journal of SurgeryContemporary Management of Primary Hyperparathyroidism
2022, Surgical Clinics of North AmericaMediastinal parathyroidectomy: Utilization of a multidisciplinary, robotic-assisted transthoracic approach in challenging cases
2022, American Journal of SurgeryCitation Excerpt :A drop in PTH >50% from preoperative baseline was indicative of surgical cure. Additionally, when a radio-guided approach was utilized, ex-vivo activity of resected tissue was measured with the hand-held Neoprobe® to confirm presence of hypercellular parathyroid tissue.24–26 For procedures without radio-guidance, frozen section of resected specimen was performed to confirm presence of hyperplastic parathyroid tissue.
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James Norman, MD, University of South Florida, Department of Surgery, P.O. Box 1289, Tampa General Hospital, Tampa, FL 33601.