La minigammacámara intraoperatoria en la cirugía del hiperparatiroidismo primario / The intraoperative mini gamma camera in primary hyperparathyroidism surgery

Introducción y objetivos: La evolución del tratamiento quirúrgico del hiperparatiroidismo primario se ha visto favorecido por la aparición de nuevas técnicas que permiten una mejor localización de las glándulas paratiroides. Recientemente se ha desarrollado una minigammacámara portátil (MGP), que permite realizar gammagrafías paratiroideas intraoperatorias. El objetivo del estudio ha sido valorar la utilidad de esta técnica. Métodos: Estudiamos prospectivamente 29 pacientes con hiperparatiroidismo primario y evaluamos la validez diagnóstica de la MGP comparando los resultados obtenidos con las técnicas preoperatorias (ecografía+gammagrafía Tc99m-sestamibi). Resultados: La sensibilidad y especificidad de la minigammacámara es superior a las técnicas preoperatorias, tanto por lado como por cuadrante del cuello (por lado: sensibilidad del 89,6% y especificidad del 96,15% frente a un 79,31 y 92,59% respectivamente, y por cuadrante: sensibilidad y especificidad del 83,33 y 90,91% versus 48,39 y 72,73%). Conclusiones: La MGP localiza de forma precisa las glándulas paratiroides patológicas, por lo que podría resultar útil al plantear una cirugía radioguiada mínimamente invasiva paratiroidea(AU)

Introduction and objectives: The evolution of primary hyperparathyroidism surgical treatment has been improved by the arrival of new techniques that allow for better parathyroid gland tracking. A mini gamma camera has recently been developed that makes it possible to take intraoperative parathyroid gammagraphies. The objective of this study was to evaluate the utility of this technique. Method: We prospectively studied 29 patients with primary hyperparathyroidism, comparing the diagnostic effectiveness of the MGP with the results obtained with preoperative techniques (ultrasound scan plus Tc99m-sestamibi gammagraphy). Results: The sensitivity and specificity of the mini gamma camera was superior to those of the preoperative techniques, applied to the lateral neck as well as to the face of the neck (lateral: 89.6% sensitivity and 96.15% specificity compared to 79.31% and 92.59% respectively; and neck face: sensitivity and specificity 83.33% and 90.91% against 48.39% and 72.73%). Conclusions: The portable mini gamma camera accurately tracks pathologic parathyroid glands. In that sense, it could be useful when considering a radio-guided surgery with minimal parathyroid invasion(AU)

The intraoperative mini gamma camera in primary hyperparathyroidism surgery.

INTRODUCTION AND OBJECTIVES: The evolution of primary hyperparathyroidism surgical treatment has been improved by the arrival of new techniques that allow for better parathyroid gland tracking. A mini gamma camera has recently been developed that makes it possible to take intraoperative parathyroid gammagraphies. The objective of this study was to evaluate the utility of this technique. METHOD: We prospectively studied 29 patients with primary hyperparathyroidism, comparing the diagnostic effectiveness of the MGP with the results obtained with preoperative techniques (ultrasound scan plus Tc(99m)-sestamibi gammagraphy). RESULTS: The sensitivity and specificity of the mini gamma camera was superior to those of the preoperative techniques, applied to the lateral neck as well as to the face of the neck (lateral: 89.6% sensitivity and 96.15% specificity compared to 79.31% and 92.59% respectively; and neck face: sensitivity and specificity 83.33% and 90.91% against 48.39% and 72.73%). CONCLUSIONS: The portable mini gamma camera accurately tracks pathologic parathyroid glands. In that sense, it could be useful when considering a radio-guided surgery with minimal parathyroid invasion.

Evaluación metodológica para detección de malignidad en patología quirúrgica tiroidea / Methodology for evaluation of malignancy screening in surgical thyroid gland disease

Introducción: Presentamos una revisión metodológica para detección de malignidad en cirugía tiroidea, comparando la palpación, la ecografía, la gammagrafía, la punción-aspiración con aguja fina (PAAF) y la biopsia extemporánea con la anatomía patológica definitiva. Material y métodos: Realizamos un estudio retrospectivo sobre una muestra de 433 (n=433) pacientes intervenidos quirúrgicamente por patología de la glándula tiroides en un mismo centro de ORL desde 1999 a 2004. Realizamos recogida de datos centrándonos en las características de la palpación cervical, la ecografía, la gammagrafía, la PAAF, la biopsia extemporánea y la anatomía patológica definitiva. Resultados: Con n=433 pacientes, la relación hombres/mujeres fue de 1/9 aproximadamente (m/f: 1/9), la edad media fue de 45,5 años, con un rango comprendido entre 13 a 87 años, y con un 20,3% de antecedentes de enfermedad tiroidea referidos; la palpación cervical, la ecografía y la gammagrafía resultaron pruebas de escaso valor para la detección de malignidad; la PAAF y la biopsia extemporánea nos aportaron un 74 y un 81% de sensibilidad y un 73 y un 92% de especificidad para la detección de malignidad. La sensibilidad específica para carcinoma papilar de la PAAF y la biopsia extemporánea fueron del 81 y del 88%, mientras que para el carcinoma folicular fueron del 66 y del 62,5%, respectivamente. Conclusiones: La PAAF es sensible en la sospecha clínica del carcinoma papilar de tiroides, aunque se debe complementar con la biopsia extemporánea por su mayor especificidad. Ante el carcinoma folicular hay tendencia al tratamiento conservador, sin realización de biopsia extemporánea y reintervención ante malignidad definitiva (AU)

Introduction: We review a methodology for detection of malignancy in thyroid gland surgery, comparing clinical exploration, ultrasonography, gammagraphy, fine-needle aspiration (FNA) and extemporaneous biopsy with the definitive pathological results. Material and methods: We carried out a retrospective study on a sample of 433 (N=433) patients who had been intervened due to thyroid gland disease at the same ENT centre between 1999 and 2004. We collected information focusing on the characteristics of cervical exploration, ultrasonography, gammagraphy, FNA, extemporaneous biopsy and definitive pathological results. Results: With N=433, the male/female ratio was approximately 1/9 (m/f 1/9), the average age was 45.5 years, with a range between 13 and 87 years, and with 20.3% of referred family history of thyroid gland disease; the cervical exploration, ultrasonography ang gammagraphy were not good tests for the screening of malignancy; FNA and extemporaneous biopsy offered 74% and 81% of sensitivity (Se), and 73% and 92% of specificity (Sp) in the detection of malignancy. The specific sensitivities towards papillary carcinoma of FNA and extemporaneous biopsy were 81% and 88%, whilst for follicular carcinoma they were 66% and 62.5%, respectively. Conclusions: FNA has good sensitivity in clinical suspicion of thyroid papillary carcinoma, although it should be complemented by extemporaneous biopsy due to its better specificity. In the case of follicular carcinoma there is a tendency towards conservative treatment, without carrying out extemporaneous biopsy previously and with reintervention in case of definitive malignancy (AU)

[Methodology for evaluation of malignancy screening in surgical thyroid gland disease]. / Evaluación metodológica para detección de malignidad en patología quirúrgica tiroidea.

INTRODUCTION: We review a methodology for detection of malignancy in thyroid gland surgery, comparing clinical exploration, ultrasonography, gammagraphy, fine-needle aspiration (FNA) and extemporaneous biopsy with the definitive pathological results. MATERIAL AND METHODS: We carried out a retrospective study on a sample of 433 (N=433) patients who had been intervened due to thyroid gland disease at the same ENT centre between 1999 and 2004. We collected information focusing on the characteristics of cervical exploration, ultrasonography, gammagraphy, FNA, extemporaneous biopsy and definitive pathological results. RESULTS: With N=433, the male/female ratio was approximately 1/9 (m/f 1/9), the average age was 45.5 years, with a range between 13 and 87 years, and with 20.3% of referred family history of thyroid gland disease; the cervical exploration, ultrasonography ang gammagraphy were not good tests for the screening of malignancy; FNA and extemporaneous biopsy offered 74% and 81% of sensitivity (Se), and 73% and 92% of specificity (Sp) in the detection of malignancy. The specific sensitivities towards papillary carcinoma of FNA and extemporaneous biopsy were 81% and 88%, whilst for follicular carcinoma they were 66% and 62.5%, respectively. CONCLUSIONS: FNA has good sensitivity in clinical suspicion of thyroid papillary carcinoma, although it should be complemented by extemporaneous biopsy due to its better specificity. In the case of follicular carcinoma there is a tendency towards conservative treatment, without carrying out extemporaneous biopsy previously and with reintervention in case of definitive malignancy.

Paraganglioma laríngeo, diagnóstico y tratamiento. A propósito de un caso / Laryngeal paraganglioma: diagnosis and treatment. A propos of a case

Los paragangliomas laríngeos (PGL) son tumores poco frecuentes, derivados del sistema neuroendocrino, que suelen iniciarse como una masa submucosa endolaríngea, con predilección por el sexo femenino. Aportamos un nuevo caso a los 77 publicados. Presentamos las características clínicas, radiológicas y quirúrgicas de un PGL supraglótico de una mujer de 40 años de edad, con clínica de 8 meses de evolución de ronquera. El tumor fue resecado mediante tirotomía lateral, previa embolización selectiva. La paciente permanece libre de enfermedad después de 18 meses tras la cirugía. La tomografía computarizada, la angiografía y la embolización preoperatorias son útiles en el diagnóstico y en la reducción del sangrado periquirúrgico. La exéresis completa vía externa con conservación mucosa es el tratamiento de elección

Paragangliomas of the larynx (LPG) are unusual neuroendocrine tumors that are seen as a vascular submucosal mass, with a female predilection. We add another case of LPG to the 77 previously reported in the literature. We present the clinical, radiologic, and surgical features of a supraglottic LPG seen in a 40-year-old woman with a 8-month history of slowly progressive hoarseness. The tumor was removed approaching a lateral thyrotomy. The patient remains disease free 18 months after surgery. Preoperative CT, angiography, and embolization are useful in making the diagnosis and reducing perisurgical bleeding of LPG before surgical intervention. Complete excision through an external mucosa-sparing approach is the treatment of choice

[Laryngeal paraganglioma: diagnosis and treatment. A propos of a case]. / Paraganglioma laríngeo, diagnóstico y tratamiento. A propósito de un caso.

Paragangliomas of the larynx (LPG) are unusual neuroendocrine tumors that are seen as a vascular submucosal mass, with a female predilection. We add another case of LPG to the 77 previously reported in the literature. We present the clinical, radiologic, and surgical features of a supraglottic LPG seen in a 40-year-old woman with a 8-month history of slowly progressive hoarseness. The tumor was removed approaching a lateral thyrotomy. The patient remains disease free 18 months after surgery. Preoperative CT, angiography, and embolization are useful in making the diagnosis and reducing perisurgical bleeding of LPG before surgical intervention. Complete excision through an external mucosa-sparing approach is the treatment of choice.