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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Comparison of intraoperative imaging with a portable gamma camera with extempora...
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Vol. 43. Issue 5.
(September - October 2024)
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Vol. 43. Issue 5.
(September - October 2024)
Original Article
Comparison of intraoperative imaging with a portable gamma camera with extemporaneous histology in minimally invasive surgery for primary hyperparathyroidism
Comparación de la imagen intraoperatoria con gammacámara portátil con la anatomía patológica extemporánea en la cirugía mínimamente invasiva del hiperparatiroidismo primario
P. Abreua,
Corresponding author
abreu_ped@gva.es

Corresponding author.
, F. Guallartb, C. Siscara, M.A. Navasa, L. Casasa, F. Montenegroa
a Servicio de Medicina Nuclear, Hospital Universitario Dr. Peset, Valencia, Spain
b Servicio de ORL, Hospital Universitario Dr. Peset, Valencia, Spain
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Table 1. Contingency table of image 2 and Histology. The True Positive, True Negative, False Positive and False Negative values are broken down.
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

92 patients underwent CMI RG--HPP with PGC after the administration of a dose of 99 mTc-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

120 excised pieces are evaluated with GGio and APio. There were 110 agreements (95TP and 15TN) and 10 disagreements (3FP and 7FN). 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.

Keywords:
Primary hyperparathyroidism
Pathology
Radioguided surgery
Minimally invasive surgical procedure
Technetium Tc-99m sestaMIBI
Parathyroid neoplasms
Resumen
Introducción

El tratamiento curativo del hiperparatiroidismo primario (HPP) es quirúrgico y hoy en día puede realizarse mediante cirugía mínimamente invasiva (CMI) y además ser radioguiado (RG) si se inyecta un radiofármaco con afinidad por el tejido paratiroideo que puede ser detectado con sondas gammadetectoras o con una gammacámara portátil (GCP).

Objetivo

El objetivo es valorar si la gammagrafía intraoperatoria (GGio) con GCP puede sustituir a la anatomía patológica intraoperatoria (APio) para determinar si la pieza extirpada es una paratiroides anormal.

Material y método

Se intervienen 92 pacientes mediante CMI-RG-HPP con GCP tras la administración de una dosis de 99 mTc-MIBI. Se compara cualitativamente (captación si/no) la información aportada por la GCP en el análisis de las piezas extirpadas con el resultado de la anatomía patológica intraoperatoria (APio). El Gold estándar es la histología definitiva.

Resultados

Se evalúan con GGio y APio 120 piezas extirpadas. Hubo 110 concordancias (95VP y 15VN) y 10 discordancias (3FP y 7FN). De las 120 lesiones, 102 correspondían a paratiroides y 18 eran no paratiroides. Hubo una buena concordancia entre la imagen por gammagrafía intraoperatoria (GGio) y la AP, del 70.1% según el índice Kappa de Cohen. La GGio presentó los siguientes valores de Sensibilidad, Especificidad, Valor Predictivo Positivo, Valor Predictivo Negativo, Razón de Verosimilitud Positiva, Razón de Verosimilitud Negativa y Valor Global de la Prueba (93.1%, 83.3%, 96.9%, 68.2%, 5.59, 0.08 y 0.92 respectivamente).

Conclusión

La GGio es una técnica de ayuda quirúrgica rápida y eficaz para confirmar/descartar la posible naturaleza paratiroidea de las lesiones extirpadas en la cirugía del HPP, pero no puede reemplazar al estudio histológico.

Palabras clave:
Hiperparatiroidismo primario
Patología
Cirugía radioguiada
Procedimientos quirúrgico mínimamente invasivo
Tecnecio Tc-99m sestaMIBI
Neoplasias de paratiroides

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