Comparación de la imagen intraoperatoria con gammacámara portátil con la anatomía patológica extemporánea en la cirugía mínimamente invasiva del hiperparatiroidismo primario

Abstract

Introduction

The curative treatment of primary hyperparathyroidism (PPH) is surgical and today it can be performed by minimally invasive surgery (MIS) and also be radioguided (RG) if a radiopharmaceutical with affinity for the parathyroid tissue that can be detected with gamma-detector probes or with a portable gamma camera (PGC) is injected.

Aim

The objective is to assess whether intraoperative scintigraphy (GGio) with PGC can replace intraoperative pathological anatomy (APio) to determine if the removed specimen is an abnormal parathyroid.

Material and method

Ninety-two patients underwent CMI-RG-HPP with PGC after administration of a dose of 99mTc-MIBI. The information provided by the PGC in the analysis of the excised specimens is qualitatively compared (capture yes/no) with the result of the intraoperative pathological anatomy (APio). The gold standard is the definitive histology.

Results

One hundred twenty excised pieces are evaluated with GGio and APio. There were 110 agreements (95 TP and 15 TN) and 10 disagreements (3 FP and 7 FN). Of the 120 lesions, 102 were parathyroid and 18 were non-parathyroid. There was good agreement between intraoperative scintigraphy imaging (GGio) and PA, 70.1% according to Cohen's Kappa index. The GGio presented the following values of sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and overall value of the test (93.1%, 83.3%, 96.9%, 68.2%, 5.59, 0.08 and 0.92 respectively).

Conclusion

GGio is a rapid and effective surgical aid technique to confirm/rule out the possible parathyroid nature of the lesions removed in PPH surgery, but it cannot replace histological study.