alexa Reexamining normative radiation data for radioguided parathyroid surgery.


Journal of Surgery

Author(s): Wineland A, Siegel E, Stack BC Jr

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Abstract OBJECTIVES: To reexamine the "Norman rule" (affected parathyroid gland would contain at least 20\% radioactivity compared with background), report normative radiation data, offer alternative ratios, and explore the effect of lapsed time on minimally invasive parathyroidectomy (MIRP). DESIGN: Retrospective analysis. SETTING: Tertiary care academic medical center. PATIENTS: A total of 116 consecutive patients who had a diagnosis of primary hyperparathyroidism, positive findings on sestamibi scan, and complete study data from 2000 to 2005 at a single institution. INTERVENTIONS: Minimally invasive radio-guided parathyroidectomy (MIRP) for primary hyperparathyroidism. MAIN OUTCOME MEASURES: Ten-second gamma radiation counts at key procedural steps. Various ratios of measured radioactivity counts were studied. RESULTS: A total of 116 patients who underwent MIRP had complete data; 91 patients waited 4 or more hours until surgery (78\%), with some waiting 8 or more hours. Every patient had a successful surgery and was observed for 1 year thereafter. The Norman ratio of radiation counts (ex vivo to background) was compared with other radiation ratios using Spearman correlation; the comparisons included skin to background (rho = 0.579), in vivo to background (rho = 0.770), basin to background (rho = 0.525), and in vivo-basin to background (rho = 0.788). Regression analysis indicated that the Norman ratio decreased over time at 11\% per hour (P = .31). CONCLUSIONS: Alternative ratios to the Norman ratio are reported. An ex vivo to background ratio greater than 20\% as a rule of successful parathyroid adenoma excision was observed in all but 2 cases in our series. This article was published in Arch Otolaryngol Head Neck Surg and referenced in Journal of Surgery

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