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Articles by R. S Sippel
Total Records ( 2 ) for R. S Sippel
  H Chen , R. S Sippel and S. Schaefer

Background  Many surgeons have shown that radio-guided resection of parathyroid glands can facilitate intraoperative localization in selected patients with primary hyperparathyroidism, especially in the reoperative setting. However, in patients with negative technetium Tc 99m–sestamibi (hereafter referred to as "sestamibi") scans, the usefulness of the gamma probe is unclear. Thus, we were interested in determining the role of radio-guided techniques in patients with primary hyperparathyroidism and negative or nonlocalizing sestamibi scans.

Design  Retrospective analysis of a prospective parathyroid database.

Setting  Academic medical center.

Patients  Seven hundred sixty-nine patients with primary hyperparathyroidism who had a sestamibi scan and underwent surgical invention by a single surgeon. All patients had radioguided parathyroidectomy using a handheld gamma probe.

Main Outcome Measures  Radioactive counts, eucalcemia rate, and complications were compared between patients with positive and patients with negative sestamibi scans.

Results  All enlarged parathyroid glands were localized with the gamma probe in patients with a negative or with a positive sestamibi scan with similar sensitivities. This occurred despite the fact that smaller parathryoid glands were present, on average, in patients with negative sestamibi scans (428 mg vs 828 mg, P = .001). Equivalent high postoperative eucalcemia rates (>98%) and low complication rates (0.5%) were achieved with radioguided techniques in both patient populations.

Conclusions  Radioguided techniques are equally effective in patients with negative (nonlocalizing) sestamibi scans undergoing parathyroidectomy for primary hyperparathyroidism. Moreover, use of the gamma probe led to the detection of all parathyroid glands, including ectopically located ones. These data suggest that the gamma probe has an important role for localization of parathyroid glands in patients with negative preoperative sestamibi scans.

  D. M Elaraj , R. S Sippel , S Lindsay , I Sansano , Q. Y Duh , O. H Clark and E. Kebebew

Hypothesis  Additional imaging studies are useful to select patients who are candidates for minimally invasive parathyroidectomy, and referral is not indicated when results from a preoperative sestamibi scan are negative.

Design, Setting, and Patients  Prospective analysis of 492 operations for primary hyperparathyroidism from May 2005 to May 2007 at a tertiary care center.

Main Outcome Measures  Accuracy of imaging studies, pathologic findings, and biochemical cure.

Results  Among the patients, 96% were cured. Of the sestamibi scan results, 91% were positive and 82% were true-positive. Ultrasonography results were positive in 51% of patients with negative sestamibi scan results, and 43% were true-positive. Patients with positive sestamibi scan results compared with those with negative sestamibi scan results had a higher rate of single-gland disease (87% vs 63%, respectively) and lower rates of double adenoma (6% vs 22%, respectively) and asymmetric hyperplasia (7% vs 15%, respectively) (P < .001). In patients with positive sestamibi scan results compared with those with negative sestamibi scan results, there was no significant difference in the rate of ectopic parathyroid glands (18% vs 12%, respectively) but there was a significant difference in cure rate (97% vs 89%, respectively) (P = .008).

Conclusions  Additional imaging with neck ultrasonography is helpful for selecting minimally invasive parathyroidectomy in most patients with primary hyperparathyroidism who have negative sestamibi scan results. Referral for parathyroidectomy may be considered in patients with negative sestamibi scan results because these results are associated with multigland disease and lower cure rates.

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