Preoperative parathyroid localization. Relevance of MIBI SPECT-CT in adverse scenarios.

PURPOSE: Selective parathyroidectomy, the treatment of choice for primary hyperparathyroidism, requires precise preoperative localization. Our purpose was to compare the accuracy and concordance of pre-surgical MIBI parathyroid scintigraphy and ultrasonography, as well as to assess the relevance of hybrid acquisition (SPECT/CT) in compromised circumstances: low-weight or ectopic adenomas, coexisting thyroid disease and re-interventions. METHODS: The study included 223 patients with primary hyperparathyroidism operated in a single Surgical Unit from August 2016 to March 2021. Preoperative ultrasonography and double-phase MIBI were performed with early SPECT/CT acquisition. A minimally invasive surgical approach was initially attempted, except in patients with concomitant thyroid surgery or multiglandular parathyroid disease. RESULTS: Selective parathyroidectomy was accomplished in 179 patients (80.2%); cervicotomy and/or thoracoscopy in 44. Removal of the parathyroid lesion was achieved in 211 patients (94.6%), corresponding 204 (96.7%) to adenomas (37 ectopic). The cure rate was 94.2%. Preoperative MIBI SPECT/CT showed higher sensitivity and accuracy (84%; 80%) compared to ultrasound (72%; 71%), being more precise in defining the exact anatomical location (75.8% vs 68.7%). These differences reached statistical significance in ectopic glands. The existence of concomitant thyroid pathology did not decrease the sensitivity of SPECT/CT (84.2%). Mean parathyroid weight was 692.2mg (95%CI: 443.5-941) in MIBI-negative cases and 1145.9mg (95%CI: 983.6-1308.3) in MIBI-positive (p=0.001). Re-intervention was successful in the 8 patients with previous surgery. CONCLUSION: MIBI SPECT/CT presents greater sensitivity, accuracy and anatomical precision than ultrasound for preoperative parathyroid localization, even in the case of ectopic glands or coexisting thyroid pathology. The weight of the pathological gland is a significantly limiting factor.

Procedimiento radioguiado en la cirugía mínimamente invasiva del hiperparatiroidismo primario / Radio-guided procedure in minimally invasive surgery for primary hyperparathyroidism

La paratiroidectomía mínimamente invasiva, de elección en la mayoría de casos de hiperparatiroidismo primario, muestra una elevada tasa de detección, fundamentada en una precisa localización preoperatoria mediante gammagrafía con MIBI (SPECT/TC) y ecografía cervical. La paratiroidectomía mínimamente invasiva radioguiada es una técnica aún más efectiva, acorta los tiempos quirúrgicos y mantiene una mínima incisión y escasas complicaciones; permite además la comprobación inmediata de la exéresis de la lesión paratiroidea y es especialmente interesante en pacientes con adenomas ectópicos o antecedentes quirúrgicos cervicales. En el presente trabajo se exponen las indicaciones, los protocolos y las diferencias entre los dos procedimientos disponibles de cirugía radioguiada mínimamente invasiva de paratiroides (MIBI y ROLL). (AU)

Minimally invasive parathyroidectomy, of choice in most cases of primary hyperparathyroidism, shows a high detection rate, based on precise preoperative localization by MIBI scintigraphy (SPECT/CT) and neck ultrasound. Radio-guided minimally invasive parathyroidectomy is an even more effective technique, which shortens surgical times, maintains minimal incision and few complications, allows immediate verification of parathyroid adenoma removal and is especially interesting in patients with ectopic lesions or cervical surgical history. In this paper, the indications, protocols and differences between the two available radio-guided parathyroid surgery procedures (MIBI and ROLL) are exposed. (AU)

Radio-guided procedure in minimally invasive surgery for primary hyperparathyroidism.

Minimally invasive parathyroidectomy, of choice in most cases of primary hyperparathyroidism, shows a high detection rate, based on precise preoperative localization by MIBI scintigraphy (SPECT/CT) and neck ultrasound. Radioguided minimally invasive parathyroidectomy is an even more effective technique, which shortens surgical times, maintains minimal incision and few complications, allows immediate verification of parathyroid adenoma removal and is especially interesting in patients with ectopic lesions or cervical surgical history. In this paper, the indications, protocols and differences between the two available radioguided parathyroid surgery procedures (MIBI and R.O.L.L.) are exposed.