Intraoperative identification of parathyroid gland pathology: A new approach

Martinez, Deborah A.; King, Denis R.; Romshe, Carolyn A.; Lozano, Rolando A.; Morris, Jamie; O’Dorisio, M. Sue; Martin, Edward W.

doi:10.1016/0022-3468(95)90491-3

Cited by 73 publications

(27 citation statements)

References 3 publications

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“…The gamma-probe is resistant, portable, not too expensive and easy to use, presenting a high sensitivity and specificity, as demonstrated by the GPAS performed to remove a wide variety of tumors [3][4][5]9,10,[20][21][22][23][24][25] and sentinel-nodes [13][14][15][16][17][18][19] . In fact, its sensitivity se- ems to be greater than that of CT (Bell et al 3 : 11 of 13 patients harboring ovarian cancer underwent preoperative CT-scan, which was normal in all of them), MRI (Martinez et al 23 : one out of three patients with parathyroid disease underwent preoperative MRI and CT, being both normal) and external scintigraphy (Martin et al 4 : this procedure was normal in 11 out of 23 patients with colorectal tumor).…”

Section: Discussionmentioning

confidence: 99%

“…In fact, its sensitivity se- ems to be greater than that of CT (Bell et al 3 : 11 of 13 patients harboring ovarian cancer underwent preoperative CT-scan, which was normal in all of them), MRI (Martinez et al 23 : one out of three patients with parathyroid disease underwent preoperative MRI and CT, being both normal) and external scintigraphy (Martin et al 4 : this procedure was normal in 11 out of 23 patients with colorectal tumor).…”

Section: Discussionmentioning

confidence: 99%

“…Although in our patient we relied basically on the digital display of the radioactive counts, we also observed a significant increase of the audible signal when the gamma probe detected both the main core of the tumor and its residual part. To make this resource even more useful, one could proceed like Martinez et al 23 . These authors eliminated (squelched) the sound of the background radioactivity in normal tissues; being the sound squelched, the criterion for the signal processor to produce a perceptible sound is a level of radioactivity significantly above background.…”

Section: Discussionmentioning

confidence: 99%

“…Martinez et al 23 used this radiotracer for GPAS in three patients with hyperparathyroidism. Two patients were operated 2-4 hours after the injection of the radiotracer, and one patient, 6 hours after it; the latter was the unique patient in whom the gamma probe failed to detect the adenoma.…”

Section: Discussionmentioning

confidence: 99%

“…This technique, named by others as radioguided surgery (RGS) and by the present authors as gamma probe-assisted surgery (GPAS), was introduced into clinical practice in 1985 by Martin et al 3,4 , allowing them to promptly recognize the lesion in 28 patients harboring colorectal tumors. Using a variety of radiolabeled substances [1][2][3][4][5][6][7][8][9][10] , many authors have performed GPAS to map sentinelnodes of melanomas 13 , of breast 14 , vulvar 15 , cervical 16 , prostate 17 , penile 18 and thyroid 19 cancer, and to identify breast (the radiolabeled substance may be injected intravenously 20 and within 21 or around 22 the tumor), ovarian 3 , colorectal 4,5 , gastroenteropancreatic 10 , parathyroid 23 and thyroid 24,25 tumors and neuroblastomas 9 , with a significant successful rate.…”

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Gamma probe-assisted brain tumor microsurgical resection: a new technique

Filho

Filho²

2002

Arq. Neuro-Psiquiatr.

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-Objectives: The pioneering performance of gamma probe-assisted surgery (GPAS) for brain tumors, aiming not only an improvement of tumor detection, but mainly assurance of its complete removal and the study of the usual distribution of the 99m Tc-MIBI in the brain SPECT of normal individuals. Method: Patient's informed consent and demonstration of the tumor by the preoperative MIBI SPECT were the inclusion criteria adopted for GPAS, which was performed in one patient with a right parietal lobe metastatic tumor. The radiotracer ( 99m Tc-MIBI) was injected in a peripheral vein 5 hours before the operation. A tumor to-normal tissue count ratio equal to or greater than 2/1 was considered indicative of tumor. MIBI SPECT was performed in five normal individuals in a pilot study. Results: The gamma probe greatly facilitated intraoperative tumor detection (tumor to-normal brain count ratio was 5/1) and indicated a small piece of residual tumor after what was thought to be a complete tumor removal, allowing its resection, which, otherwise, would have been left behind. Postoperative CT confirmed complete tumor resection. The MIBI SPECT in normal individuals showed an increased uptake by the hypophisis, choroid plexus, skull, scalp and salivary glands and absence of uptake by the normal brain tissue. There were no complications. Conclusion: GPAS proved to be, in this single case, a safe and reliable technique to improve brain tumor detection and to confirm the presence or absence of residual tumor.KEY WORDS: radioguided surgery, gamma probe, gamma probe-assisted surgery, 99m Tc-MIBI, SPECT, brain tumor, brain neoplasm.Ressecção microcirúrgica de tumor cerebral assistida por detector gama: uma nova técnica RESUMO -Objetivos: A realização pioneira de cirurgia assistida por detector gama (CADG) para tumores cerebrais, objetivando-se não apenas a identificação do tumor, mas, sobretudo, assegurar-se quanto à sua completa ressecção e estudar a distribuição usual do 99m Tc-MIBI no SPECT cerebral de indivíduos normais. Método: O consentimento informado do paciente e a demonstração do tumor pelo SPECT pré-operatório com MIBI foram os critérios de inclusão adotados para a CADG, a qual foi realizada em um paciente com metástase para lobo parietal direito. O radiotraçador ( 99m Tc-MIBI) foi injetado em uma veia periférica 5 horas antes da cirurgia. Uma relação ≥ 2/1 entre a radiação gama emitida pelo tumor e pelo tecido normal foi considerada como indicativa de presença tumoral. Em um estudo piloto, SPECT cerebral com MIBI foi realizado em cinco pacientes normais. Resultados: O detector gama em muito facilitou a detecção per-operatória do tumor e demonstrou a presença de um pequeno resíduo tumoral após o que se pensou tratar-se de uma completa ressecção; tal resíduo, de outro modo, não teria sido percebido, o que teria impossibilitado sua exérese. Tomografia computorizada pós-operatória confirmou a completa ressecção do tumor. O SPECT com MIBI de indivíduos normais mostrou sua captação pela hipófise, plexo coróide, crânio, co...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Gamma probe-assisted brain tumor microsurgical resection: a new technique

Filho

Filho²

2002

Arq. Neuro-Psiquiatr.

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Radioguidance Is Not Necessary During Parathyroidectomy

Inabnet

Kim²,

Haber³

et al. 2002

Arch Surg

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Background: Improvements in the accuracy of preoperative localization and the availability of the rapid parathyroid hormone assay have permitted minimally invasive parathyroidectomy in patients with primary hyperparathyoidism. Hypothesis: The use of intraoperative radioguidance is beneficial during targeted parathyroid operations. Design: A retrospective analysis of a prospective database of patients. Setting: Tertiary care referral center. Patients: During a 2 1 ⁄2-year period, 130 patients underwent minimally invasive, targeted parathyroidectomy with intraoperative monitoring of the parathyroid hormone level. Of these, 60 patients underwent radioguided parathyroidectomy. Prior to surgery, a solitary parathyroid adenoma was visualized on technetium Tc 99m sestamibi scintigraphy in all patients selected for radioguided parathyroidectomy. A gamma probe was used to guide the surgical dissection. Results: All patients were cured following radioguided parathyroidectomy. In 29 patients (48%), the probe provided confusing or inaccurate information; however, a unilateral neck exploration with excision of a parathyroid adenoma was successfully completed in each of these patients. Forty-three cases were completed under local anesthesia and 85% were discharged home on the same day of surgery. There was 1 temporary recurrent laryngeal nerve palsy. Conclusion: In the era of improved preoperative localization and intraoperative parathyroid hormone monitoring, the routine use of radioguidance is not recommended during parathyroidectomy.

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Radioguided Parathyroidectomy

Oltmann¹,

Chen²

2013

Minimally Invasive and Robotic Thyroid and Parathyroid Surgery

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Intraoperative identification of parathyroid gland pathology: A new approach

Cited by 73 publications

References 3 publications

Gamma probe-assisted brain tumor microsurgical resection: a new technique

Gamma probe-assisted brain tumor microsurgical resection: a new technique

Radioguidance Is Not Necessary During Parathyroidectomy

Radioguided Parathyroidectomy

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