PARATHYROIDECTOMIES USING INTRAOPERATIVE SESTAMIBI RADIONUCLIDE LOCALIZATION IN NON- LOCALIZING PARATHYROID ADENOMA BY SESTAMIBI IMAGING caroline.liu@unlv.edu

396-07

PARATHYROIDECTOMIES USING INTRAOPERATIVE SESTAMIBI RADIONUCLIDE LOCALIZATION IN NON- LOCALIZING PARATHYROID ADENOMA BY SESTAMIBI IMAGING

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United States

Oral or Poster

The role of intraoperative sestamibi radionuclide localization in parathyroid surgery in non-localizing parathyroid adenomas has not been well characterized.

This is a retrospective study of all parathyroidectomies carried out by a single surgeon from November 2019 to October 2023. We collected data on demographics, imaging, preoperative and intraoperative labs, pathology findings, surgical time, and sestamibi levels. Localizing and non-localizing adenomas were defined by sestamibi scan reports. Each patient was injected with Technetium-99m sestamibi preoperatively. In the operating room, a Neoprobe (Devicor Medical Products) was used to measure outputs in different quadrants of the thyroid to help guide surgery. After removal of the suspected parathyroid adenoma, background output levels were measured at the Neoprobe level of the thyroid. Parathyroid adenoma ex-vivo output levels were measured with the excised adenoma placed on the chest away from the thyroid bed. Primary outcomes were surgical times, adenoma weight, and ratio of parathyroid adenoma ex-vivo to background. P values were determined using t-testing.

Average time to excision (minutes), weight of adenoma (mg) and Neoprobe ratio of ex-vivo adenoma to background for localizing and non-localizing parathyroid adenomas were (34.1 vs 38.7 minutes, p= 0.15), (1434.8 vs 745.5 mg, p= 0.013), and (2.07 vs 1.79, p=0.073), respectively.

Intra-operative sestamibi radionucleotide localization can be helpful for non-localizing parathyroid adenomas with comparable surgical times as they are on average 1.79 times greater than background Neoprobe levels. Smaller adenomas may be more difficult to localize on intraoperative sestamibi due to relative smaller uptake.