Lumachi F, Zucchetta P, Angelini F, Borsato N, Polistina F, Favia G, D'Amico D F
Dept. of Surgical & Gastroenterological Sciences Nuclear Medicine, University of Padua, School of Medicine, Padova, Italy.
J Exp Clin Cancer Res. 2000 Mar;19(1):7-11.
Primary hyperparathyroidism is the most common cause of hypercalcemia and 80-85% of the patients have parathyroid tumors. The purpose of this retrospective review was to analyse whether differences exist between patients with parathyroid tumors treated in the 1980s and 1990s. Between 1980-1997, 253 patients underwent initial surgical neck exploration for hyperfunctioning parathyroid tumors. Renal (polyuria, nocturia, renal colic due to lithiasis), rheumatologic (bone and joint pain), neurological (fatigue, memory loss, depression) and gastrointestinal (dyspepsia, anorexia, nausea) symptoms were recorded and main biochemical parameters were measured. In all patients one or more preoperative localization procedures were carried out prior to successful parathyroidectomy, and the confirmation of imaging findings was obtained after surgery. The patients were divided in two groups. Group A: 121 (47.8%) patients who underwent surgery from 1980-1989; Group B: 132 (52.2%) patients in whom parathyroidectomy was performed from 1990-1997. There were no differences (p=NS) between the two groups in average age, preoperative serum creatinine and intact-PTH levels. Symptoms were most common in Group A, and pre-operative serum calcium levels were significantly lower in Group B. Ultrasonography (n=191) sensitivity did not improve significantly (82.8% vs 82.9%), but positive predictive value (PPV) was higher (89.8% vs 96.0%). CT-scan (n=73) sensitivity was 79.2% and 82.6%, and PPV was 95.0% and 100% in Groups A and B, respectively. 201Tl/99mTc subtraction scintigraphy (n=111, Group A) was 84.6% sensitive (PPV=92.6%) whereas 99mTc-sestamibi scanning (n=90, Group B) was 85.1% sensitive (PPV=96.1%). In conclusion, the clinical features of parathyroid tumors has changed in the nineties and increasing asymptomatic pHPT rate has been found. Although sensitivity and PPV of preoperative localization procedures has improved moderately, at present noninvasive techniques may offer excellent results and should be used in all patients with suspected parathyroid tumors.
原发性甲状旁腺功能亢进是高钙血症最常见的病因，80%至85%的患者患有甲状旁腺肿瘤。本回顾性研究的目的是分析20世纪80年代和90年代接受治疗的甲状旁腺肿瘤患者之间是否存在差异。1980年至1997年间，253例患者因甲状旁腺功能亢进肿瘤接受了首次颈部手术探查。记录了肾脏（多尿、夜尿、结石引起的肾绞痛）、风湿性（骨和关节疼痛）、神经学（疲劳、记忆力减退、抑郁）和胃肠道（消化不良、厌食、恶心）症状，并测量了主要生化参数。所有患者在成功进行甲状旁腺切除术前均进行了一项或多项术前定位检查，并在术后获得了影像学检查结果的确认。患者分为两组。A组：1980年至1989年接受手术的121例（47.8%）患者；B组：1990年至1997年接受甲状旁腺切除术的132例（52.2%）患者。两组在平均年龄、术前血清肌酐和完整甲状旁腺激素水平方面无差异（p=无显著性差异）。症状在A组最为常见，B组术前血清钙水平显著较低。超声检查（n=191）的敏感性没有显著提高（82.8%对82.9%），但阳性预测值（PPV）较高（89.8%对96.0%）。CT扫描（n=73）在A组和B组的敏感性分别为79.2%和82.6%，PPV分别为95.0%和100%。201Tl/99mTc减影闪烁扫描（n=111，A组）的敏感性为84.6%（PPV=92.6%），而99mTc-甲氧基异丁基异腈扫描（n=90，B组）的敏感性为85.1%（PPV=96.1%）。总之，20世纪90年代甲状旁腺肿瘤的临床特征发生了变化，无症状原发性甲状旁腺功能亢进症的发生率有所增加。虽然术前定位检查的敏感性和PPV有适度提高，但目前非侵入性技术可能会提供出色的结果，应在所有疑似甲状旁腺肿瘤的患者中使用。
