Olson Jordan, Repplinger Dan, Bianco Jesus, Chen Herbert
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison Wisconsin 53792, USA.
J Surg Res. 2006 Dec;136(2):187-91. doi: 10.1016/j.jss.2006.04.024. Epub 2006 Oct 16.
Radioguided parathyroidectomy using TC-99m-sestamibi injection and the handheld gamma probe allows more precise and rapid intraoperative localization of abnormal parathyroid glands. This technique is based on the principle that hypercellular parathyroid tissues have markedly higher in vivo radiotracer counts than surrounding tissue including thyroid and lymph nodes. While in vivo radioactivity after TC-99m-sestamibi administration in various tissues has been documented, there is a lack of data regarding ex vivo radioactive properties after surgical resection.
During a 6-week period in June/July 2005, 21 patients underwent radioguided parathyroidectomy by a single surgeon. Fifty-four tissue samples (39 parathyroid, 15 nonparathyroid) from these patients were collected and analyzed for ex vivo radioactive counts over a 30-min period. These data were then compared with the pathologic results.
There is a significant difference in ex vivo counts between parathyroid adenomas, hyperplastic glands, and nonparathyroid tissue immediately after resection. However, radioactive decay/slope rates do not differ between the tissues. Importantly, an ex vivo count of >20% of background is 100% specific for parathyroid tissue. These differences persisted for up to 30 min.
This is the first comprehensive study of ex vivo radioactive properties after TC-99m-sestamibi injection during radioguided parathyroidectomy. Parathyroids have a greater rate of uptake compared to nonparathyroid tissue, allowing ex vivo counts to predict tissue type. These tissues have similar decay rates, allowing these predictions to be made anytime up to 30 min after gland resection.
使用锝-99m-甲氧基异丁基异腈注射剂和手持式γ探头进行放射性引导甲状旁腺切除术，可在术中更精确、快速地定位异常甲状旁腺。该技术基于这样的原理：甲状旁腺组织细胞增多时，其体内放射性示踪剂计数明显高于包括甲状腺和淋巴结在内的周围组织。虽然已记录了锝-99m-甲氧基异丁基异腈给药后各种组织的体内放射性，但缺乏手术切除后离体放射性特性的数据。
在2005年6月/7月的6周内，由一名外科医生对21例患者进行放射性引导甲状旁腺切除术。收集这些患者的54份组织样本（39份甲状旁腺组织、15份非甲状旁腺组织），并在30分钟内分析其离体放射性计数。然后将这些数据与病理结果进行比较。
切除后立即测量，甲状旁腺腺瘤、增生性腺和非甲状旁腺组织的离体计数存在显著差异。然而，不同组织的放射性衰变/斜率率并无差异。重要的是，离体计数>背景值的20%对甲状旁腺组织具有100%的特异性。这些差异可持续长达30分钟。
这是第一项关于放射性引导甲状旁腺切除术中注射锝-99m-甲氧基异丁基异腈后离体放射性特性的综合研究。与非甲状旁腺组织相比甲状旁腺的摄取率更高，使得离体计数能够预测组织类型。这些组织具有相似的衰变率，使得在腺体切除后长达30分钟的任何时间都能进行这些预测。
