Minimally invasive parathyroid surgery, the Norman 20% rule: is it valid?
The 20 per cent rule proposed by Norman established a guideline using radioactivity in the minimally invasive radioguided parathyroidectomy (MIRP) technique to localize and confirm removal of an abnormal parathyroid gland in patients with primary hyperparathyroidism. If radioactivity in the resected...
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| Veröffentlicht in: | The American surgeon 2011-04, Vol.77 (4), p.484-487 |
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| creator | Quillo, Amy R Bumpous, Jeffery M Goldstein, Richard E Fleming, Muffin M Flynn, Michael B |
| description | The 20 per cent rule proposed by Norman established a guideline using radioactivity in the minimally invasive radioguided parathyroidectomy (MIRP) technique to localize and confirm removal of an abnormal parathyroid gland in patients with primary hyperparathyroidism. If radioactivity in the resected gland was at least 20 per cent of excision site/background radioactivity, the 20 per cent rule was satisfied. Patients meeting these criteria underwent unilateral MIRP without intraoperative parathyroid hormone assay or intraoperative frozen section. The study aim was to independently evaluate the 20 per cent rule in MIRP patients with primary hyperparathyroidism. Using the University of Louisville Parathyroid Database from January 1, 1999 to December 31, 2007, 216 MIRP patients with complete radioguided and postoperative management data were identified. The average percentage of ex vivo parathyroid gland radioactivity compared with excision site/background radioactivity was 107 per cent with a range from 14 to 388 per cent. For 99 per cent (196/198) radioactivity recorded from the excised gland was at least 20 per cent of radioactivity recorded from the excision site. Normocalcemia was documented in 98.5 per cent (195/198) at 12 month follow-up. Our data supports the 20 per cent rule in that in 99 per cent of MIRP patients the resected gland radioactivity was at least 20 per cent of excision site radioactivity allowing localization and confirmation of an overactive gland without intraoperative parathyroid hormone monitoring or tissue analysis. |
| doi_str_mv | 10.1177/000313481107700428 |
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If radioactivity in the resected gland was at least 20 per cent of excision site/background radioactivity, the 20 per cent rule was satisfied. Patients meeting these criteria underwent unilateral MIRP without intraoperative parathyroid hormone assay or intraoperative frozen section. The study aim was to independently evaluate the 20 per cent rule in MIRP patients with primary hyperparathyroidism. Using the University of Louisville Parathyroid Database from January 1, 1999 to December 31, 2007, 216 MIRP patients with complete radioguided and postoperative management data were identified. The average percentage of ex vivo parathyroid gland radioactivity compared with excision site/background radioactivity was 107 per cent with a range from 14 to 388 per cent. For 99 per cent (196/198) radioactivity recorded from the excised gland was at least 20 per cent of radioactivity recorded from the excision site. Normocalcemia was documented in 98.5 per cent (195/198) at 12 month follow-up. Our data supports the 20 per cent rule in that in 99 per cent of MIRP patients the resected gland radioactivity was at least 20 per cent of excision site radioactivity allowing localization and confirmation of an overactive gland without intraoperative parathyroid hormone monitoring or tissue analysis.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/000313481107700428</identifier><identifier>PMID: 21679561</identifier><language>eng</language><publisher>United States: SAGE PUBLICATIONS, INC</publisher><subject>Calcium - blood ; Clinical medicine ; Colleges & universities ; Decision Support Techniques ; Humans ; Hyperparathyroidism - diagnostic imaging ; Hyperparathyroidism - surgery ; Medical imaging ; Minimally Invasive Surgical Procedures ; Parathyroidectomy - methods ; Patient Selection ; Postoperative Complications ; Radiometry ; Radionuclide Imaging ; Radiopharmaceuticals ; Reproducibility of Results ; Retrospective Studies ; Surgery ; Technetium Tc 99m Sestamibi ; Treatment Outcome</subject><ispartof>The American surgeon, 2011-04, Vol.77 (4), p.484-487</ispartof><rights>Copyright Southeastern Surgical Congress Apr 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c373t-faa737895dd12b19e9a002863253a9bdaf7bc4239446bfa03a0a10b69b4da5a63</citedby><cites>FETCH-LOGICAL-c373t-faa737895dd12b19e9a002863253a9bdaf7bc4239446bfa03a0a10b69b4da5a63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21679561$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Quillo, Amy R</creatorcontrib><creatorcontrib>Bumpous, Jeffery M</creatorcontrib><creatorcontrib>Goldstein, Richard E</creatorcontrib><creatorcontrib>Fleming, Muffin M</creatorcontrib><creatorcontrib>Flynn, Michael B</creatorcontrib><title>Minimally invasive parathyroid surgery, the Norman 20% rule: is it valid?</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>The 20 per cent rule proposed by Norman established a guideline using radioactivity in the minimally invasive radioguided parathyroidectomy (MIRP) technique to localize and confirm removal of an abnormal parathyroid gland in patients with primary hyperparathyroidism. If radioactivity in the resected gland was at least 20 per cent of excision site/background radioactivity, the 20 per cent rule was satisfied. Patients meeting these criteria underwent unilateral MIRP without intraoperative parathyroid hormone assay or intraoperative frozen section. The study aim was to independently evaluate the 20 per cent rule in MIRP patients with primary hyperparathyroidism. Using the University of Louisville Parathyroid Database from January 1, 1999 to December 31, 2007, 216 MIRP patients with complete radioguided and postoperative management data were identified. The average percentage of ex vivo parathyroid gland radioactivity compared with excision site/background radioactivity was 107 per cent with a range from 14 to 388 per cent. For 99 per cent (196/198) radioactivity recorded from the excised gland was at least 20 per cent of radioactivity recorded from the excision site. Normocalcemia was documented in 98.5 per cent (195/198) at 12 month follow-up. Our data supports the 20 per cent rule in that in 99 per cent of MIRP patients the resected gland radioactivity was at least 20 per cent of excision site radioactivity allowing localization and confirmation of an overactive gland without intraoperative parathyroid hormone monitoring or tissue analysis.</description><subject>Calcium - blood</subject><subject>Clinical medicine</subject><subject>Colleges & universities</subject><subject>Decision Support Techniques</subject><subject>Humans</subject><subject>Hyperparathyroidism - diagnostic imaging</subject><subject>Hyperparathyroidism - surgery</subject><subject>Medical imaging</subject><subject>Minimally Invasive Surgical Procedures</subject><subject>Parathyroidectomy - methods</subject><subject>Patient Selection</subject><subject>Postoperative Complications</subject><subject>Radiometry</subject><subject>Radionuclide Imaging</subject><subject>Radiopharmaceuticals</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Technetium Tc 99m Sestamibi</subject><subject>Treatment Outcome</subject><issn>0003-1348</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNplkEtLw0AUhQdRbK3-ARcyCOLG6Lwn40ak-ChU3eg63CQTOyVN6kxSyL83odWFri4HvnO4fAidUnJNqdY3hBBOuYgpJVoTIli8h8ZUShmZmPF9NB6AaCBG6CiEZR-FkvQQjRhV2khFx2j24iq3grLssKs2ENzG4jV4aBadr12OQ-s_re-ucLOw-LX2K6gwIxfYt6W9xS5g1-ANlC6_O0YHBZTBnuzuBH08PrxPn6P529Nsej-PMq55ExUAmuvYyDynLKXGGiCExYozycGkORQ6zQTjRgiVFkA4EKAkVSYVOUhQfIIut7trX3-1NjTJyoXMliVUtm5DEmsmuKbc9OT5H3JZt77qn0sMkUqomA5zbAtlvg7B2yJZ-16I7xJKkkFz8l9zXzrbLbfpyua_lR-v_BsxEXVu</recordid><startdate>201104</startdate><enddate>201104</enddate><creator>Quillo, Amy R</creator><creator>Bumpous, Jeffery M</creator><creator>Goldstein, Richard E</creator><creator>Fleming, Muffin M</creator><creator>Flynn, Michael B</creator><general>SAGE PUBLICATIONS, INC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7QL</scope><scope>7RV</scope><scope>7T7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>201104</creationdate><title>Minimally invasive parathyroid surgery, the Norman 20% rule: is it valid?</title><author>Quillo, Amy R ; Bumpous, Jeffery M ; Goldstein, Richard E ; Fleming, Muffin M ; Flynn, Michael B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c373t-faa737895dd12b19e9a002863253a9bdaf7bc4239446bfa03a0a10b69b4da5a63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Calcium - blood</topic><topic>Clinical medicine</topic><topic>Colleges & universities</topic><topic>Decision Support Techniques</topic><topic>Humans</topic><topic>Hyperparathyroidism - diagnostic imaging</topic><topic>Hyperparathyroidism - surgery</topic><topic>Medical imaging</topic><topic>Minimally Invasive Surgical Procedures</topic><topic>Parathyroidectomy - methods</topic><topic>Patient Selection</topic><topic>Postoperative Complications</topic><topic>Radiometry</topic><topic>Radionuclide Imaging</topic><topic>Radiopharmaceuticals</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Technetium Tc 99m Sestamibi</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Quillo, Amy R</creatorcontrib><creatorcontrib>Bumpous, Jeffery M</creatorcontrib><creatorcontrib>Goldstein, Richard E</creatorcontrib><creatorcontrib>Fleming, Muffin M</creatorcontrib><creatorcontrib>Flynn, Michael B</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Science Database (ProQuest)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Quillo, Amy R</au><au>Bumpous, Jeffery M</au><au>Goldstein, Richard E</au><au>Fleming, Muffin M</au><au>Flynn, Michael B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Minimally invasive parathyroid surgery, the Norman 20% rule: is it valid?</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2011-04</date><risdate>2011</risdate><volume>77</volume><issue>4</issue><spage>484</spage><epage>487</epage><pages>484-487</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><abstract>The 20 per cent rule proposed by Norman established a guideline using radioactivity in the minimally invasive radioguided parathyroidectomy (MIRP) technique to localize and confirm removal of an abnormal parathyroid gland in patients with primary hyperparathyroidism. If radioactivity in the resected gland was at least 20 per cent of excision site/background radioactivity, the 20 per cent rule was satisfied. Patients meeting these criteria underwent unilateral MIRP without intraoperative parathyroid hormone assay or intraoperative frozen section. The study aim was to independently evaluate the 20 per cent rule in MIRP patients with primary hyperparathyroidism. Using the University of Louisville Parathyroid Database from January 1, 1999 to December 31, 2007, 216 MIRP patients with complete radioguided and postoperative management data were identified. The average percentage of ex vivo parathyroid gland radioactivity compared with excision site/background radioactivity was 107 per cent with a range from 14 to 388 per cent. For 99 per cent (196/198) radioactivity recorded from the excised gland was at least 20 per cent of radioactivity recorded from the excision site. Normocalcemia was documented in 98.5 per cent (195/198) at 12 month follow-up. Our data supports the 20 per cent rule in that in 99 per cent of MIRP patients the resected gland radioactivity was at least 20 per cent of excision site radioactivity allowing localization and confirmation of an overactive gland without intraoperative parathyroid hormone monitoring or tissue analysis.</abstract><cop>United States</cop><pub>SAGE PUBLICATIONS, INC</pub><pmid>21679561</pmid><doi>10.1177/000313481107700428</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Calcium - blood Clinical medicine Colleges & universities Decision Support Techniques Humans Hyperparathyroidism - diagnostic imaging Hyperparathyroidism - surgery Medical imaging Minimally Invasive Surgical Procedures Parathyroidectomy - methods Patient Selection Postoperative Complications Radiometry Radionuclide Imaging Radiopharmaceuticals Reproducibility of Results Retrospective Studies Surgery Technetium Tc 99m Sestamibi Treatment Outcome |
| title | Minimally invasive parathyroid surgery, the Norman 20% rule: is it valid? |
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