Gotthardt Martin, Lohmann Bodo, Behr Thomas M, Bauhofer Artur, Franzius Christiane, Schipper Meike L, Wagner Maria, Höffken Helmut, Sitter Helmut, Rothmund Matthias, Joseph Klaus, Nies Christoph
Department of Nuclear Medicine, Philipps-University of Marburg, Baldingerstrasse, 35043 Marburg, Germany.
World J Surg. 2004 Jan;28(1):100-7. doi: 10.1007/s00268-003-6991-y. Epub 2003 Nov 26.
There is a considerable discrepancy in the literature concerning the sensitivity of parathyroid scintigraphy (PS) with 99mTc-MIBI. We therefore analyzed our own data and compared them to the literature in a metaanalysis. All patients who received 99mTc -MIBI scintigraphy and subsequent surgery in our department for the detection of enlarged parathyroid glands in primary (pHPT) or secondary (sHPT) hyperparathyroidism between 1991 and 1999 were included in our retrospective analysis. The results of surgery served as the gold standard. For a true positive result, the scintigraphy had to predict the exact location of parathyroid adenoma (PA) or parathyroid hyperplasia (PH). We then compared these data to the results of a nonstatistical systematic metaanalysis of the literature. Patients (178) underwent PS between 1991 and 1999; 139 were operated on and included in this study. Of these, 109 had pHPT and 30 had sHPT. The sensitivity and specificity of the PS were found to be 45%/94% for pHPT and 39%/40% for sHPT. Fifty-two studies concerning PS were included in the metaanalysis. Sensitivities reported varied from 39% to >90%. Consideration of the different possible techniques used for PS could not explain these discrepancies. Our data show that the sensitivity of PS in clinical routine may be lower than expected from the literature. Our data are consistent with other studies and with partially unpublished clinical observations from other university hospitals. We believe that a well-designed and properly conducted prospective study is necessary to evaluate the reasons for the differences observed.
关于99mTc-MIBI甲状旁腺闪烁扫描术（PS）的敏感性，文献中存在相当大的差异。因此，我们分析了自己的数据，并在一项荟萃分析中将其与文献进行了比较。1991年至1999年间，在我们科室接受99mTc-MIBI闪烁扫描术及后续手术以检测原发性（pHPT）或继发性（sHPT）甲状旁腺功能亢进中增大的甲状旁腺的所有患者均纳入我们的回顾性分析。手术结果作为金标准。对于真正的阳性结果，闪烁扫描术必须预测甲状旁腺腺瘤（PA）或甲状旁腺增生（PH）的确切位置。然后，我们将这些数据与文献的非统计学系统荟萃分析结果进行了比较。1991年至1999年间，178例患者接受了PS检查；其中139例接受了手术并纳入本研究。其中，109例患有pHPT，30例患有sHPT。发现PS对pHPT的敏感性和特异性分别为45%/94%，对sHPT为39%/40%。荟萃分析纳入了52项关于PS的研究。报告的敏感性从39%到>90%不等。考虑到用于PS的不同可能技术无法解释这些差异。我们的数据表明，PS在临床常规中的敏感性可能低于文献预期。我们的数据与其他研究以及其他大学医院部分未发表的临床观察结果一致。我们认为，有必要进行一项设计良好且实施得当的前瞻性研究，以评估观察到的差异的原因。
