Norman J G, Jaffray C E, Chheda H
Department of Surgery, University of South Florida, Tampa 33601, USA.
Ann Surg. 2000 Jan;231(1):31-7. doi: 10.1097/00000658-200001000-00005.
To demonstrate that the positive parathyroid sestamibi scan, if correctly interpreted and applied, truly represents a parathyroid adenoma, never a "false-positive" scan.
Although the sestamibi scan is widely ordered preoperatively to locate parathyroid adenomas, concern about a false-positive scan often causes surgeons to distrust the results. Tissues such as thyroid adenomas and lymph nodes have been blamed for false-positive studies, but the radioactivity of these presumed false-positive tissues has never been measured.
Over an 1 8-month period, 17 patients were referred for persistent primary hyperparathyroidism after undergoing at least one neck exploration. All patients had a sestamibi scan prior to their initial operation that was interpreted as clearly positive and then, during or after an unsuccessful operation, deemed false-positive by the surgeon. At the authors' institution, all patients underwent repeat sestamibi scintigraphy and were taken to the operating room while radioactive for a minimally invasive radioguided parathyroidectomy (MIRP).
The authors' sestamibi scans demonstrated the same single focus of radioactivity displayed on the outside scans, clearly positive. During MIRP, an adenoma was successfully located and removed in all patients, with confirmation of the diagnosis by quantitative differential radioactivity and subsequent histologic examination. Removal of the radioactive tissue cured all patients.
Intraoperative nuclear mapping permitted identification and removal of parathyroid adenomas in all patients with positive sestamibi scans that had previously been labelled false-positive, indicating that each patient would have been cured during their previous operation if radioguided techniques were used. Surgeons should be extremely cautious in deciding intraoperatively that a positive sestamibi scan is a false-positive scan.
证明如果正确解读和应用，甲状旁腺 sestamibi 扫描呈阳性确实代表甲状旁腺腺瘤，而非“假阳性”扫描。
尽管术前广泛进行 sestamibi 扫描以定位甲状旁腺腺瘤，但对假阳性扫描的担忧常使外科医生不信任其结果。甲状腺腺瘤和淋巴结等组织被认为是假阳性研究的原因，但这些假定的假阳性组织的放射性从未被测量过。
在 18 个月的时间里，17 例患者在至少接受一次颈部探查后因持续性原发性甲状旁腺功能亢进前来就诊。所有患者在初次手术前均进行了 sestamibi 扫描，结果被明确解读为阳性，但在手术失败期间或之后，外科医生认为是假阳性。在作者所在机构，所有患者均接受了重复 sestamibi 闪烁扫描，并在放射性状态下被送往手术室进行微创放射性引导甲状旁腺切除术（MIRP）。
作者的 sestamibi 扫描显示出与外部扫描相同的单一放射性焦点，明确为阳性。在 MIRP 过程中，所有患者均成功定位并切除腺瘤，通过定量差异放射性及随后的组织学检查确诊。切除放射性组织使所有患者均获治愈。
术中核素定位允许在所有 sestamibi 扫描呈阳性但先前被标记为假阳性的患者中识别并切除甲状旁腺腺瘤，这表明如果使用放射性引导技术，每位患者在先前手术中都可获治愈。外科医生在术中判定 sestamibi 扫描阳性为假阳性扫描时应极其谨慎。
