Relative Contributions of Technetium Tc 99m Sestamibi Scintigraphy, Intraoperative Gamma Probe Detection, and the Rapid Parathyroid Hormone Assay to the Surgical Management of Hyperparathyroidism

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Abstract
RECENT REPORTS have documented that most patients with primary hyperparathyroidism can undergo a directed, anatomic, unilateral operation with a high degree of success and low morbidity using the combination of a preoperative sestamibi scan and either an intraoperative rapid parathyroid hormone (rPTH) assay1-5 or intraoperative localization of sestamibi-labeled parathyroid tissue by the use of a handheld gamma detector.6-8 The latter technique, in particular, has been advocated by some authors as an important component of minimally invasive outpatient parathyroidectomy using very small incisions and local anesthesia.7,8 Both of these techniques individually have been applied to the treatment of patients undergoing an initial parathyroid exploration and those undergoing a second parathyroid surgery. We report our initial experience comparing our results with these 2 techniques in a series of patients with hyperparathyroidism. This series is unique in that most of these patients were treated using both the intraoperative rPTH assay and intraoperative parathyroid gamma probe localization.