Goldstein Richard E, Carter William M, Fleming Muffin, Bumpous Jeffrey, Lentsch Eric, Rice Michael, Flynn Michael
Department of Surgery, University of Louisville, Louisville, KY 40202, USA.
Arch Surg. 2006 Jun;141(6):552-7; discussion 557-9. doi: 10.1001/archsurg.141.6.552.
Equivocal parathyroid technetium Tc 99m sestamibi scan results are likely to demonstrate the correct location for parathyroid adenomas.
Patients with primary hyperparathyroidism prospectively consented to participate in an institutional review board-approved study. The parathyroid technetium Tc 99m sestamibi scan results were classified as positive, negative, or equivocal.
A tertiary private hospital in which university faculty practice.
Technetium Tc 99m sestamibi imaging was performed for 464 patients with primary hyperparathyroidism. Eighty-four of these patients had scan results considered equivocal for unilateral adenomas. The algorithm for this group of patients specified that they should receive an injection with technetium Tc 99m sestamibi prior to parathyroidectomy and that an intraoperative parathyroid hormone (iPTH) level decrease of more than 50% be used to define intraoperative success. Seventy-two patients had postoperative calcium levels measured at least 2 weeks after their surgical procedure and defined the study group. The mean follow-up was more than 6 months.
Parathyroidectomy.
Correlation of equivocal scan interpretation with operative findings and biochemical cure of hyperparathyroidism.
Of the 72 patients, 39 underwent unilateral surgical explorations and 33 underwent bilateral surgical explorations; 67 (93%) of the patients were initially cured and 68 (94%) were ultimately cured. In the unilateral group, 38 (97%) of the patients were cured. The 1 failure was associated with a false-positive iPTH level decrease. In the bilateral group, 29 (88%) of the patients were initially cured and 30 (91%) were ultimately cured. Two failures were associated with a false-positive iPTH level decrease and 2 with failure to find the adenoma. Of the 33 patients in the bilateral group, surgical exploration of the opposite side was purely by surgeon choice in 11 cases. Of the other 22 patients, in addition to the 3 failures, 7 had 4-gland hyperplasia, 4 had double adenomas, and 6 had false-negative iPTH level results with iPTH level decreases of less than 50%.
Overall, between 48 (67%) and 54 (75%) of the 72 patients would have been cured with unilateral surgical exploration alone.
甲状旁腺99m锝甲氧基异丁基异腈扫描结果不明确时，很可能显示出甲状旁腺腺瘤的正确位置。
原发性甲状旁腺功能亢进患者前瞻性地同意参与一项经机构审查委员会批准的研究。甲状旁腺99m锝甲氧基异丁基异腈扫描结果被分类为阳性、阴性或不明确。
一所大学教师执业的三级私立医院。
对464例原发性甲状旁腺功能亢进患者进行了99m锝甲氧基异丁基异腈显像。其中84例患者的扫描结果被认为对于单侧腺瘤不明确。针对这组患者的算法规定，他们应在甲状旁腺切除术前接受99m锝甲氧基异丁基异腈注射，并且术中甲状旁腺激素（iPTH）水平下降超过50%被用于定义术中成功。72例患者在手术后至少2周测量了术后血钙水平，并构成了研究组。平均随访时间超过6个月。
甲状旁腺切除术。
扫描结果不明确的解读与手术结果及甲状旁腺功能亢进生化治愈情况的相关性。
72例患者中，39例行单侧手术探查，33例行双侧手术探查；67例（93%）患者最初治愈，68例（94%）最终治愈。在单侧组中，38例（97%）患者治愈。1例失败与iPTH水平下降假阳性有关。在双侧组中，29例（88%）患者最初治愈，30例（91%）最终治愈。2例失败与iPTH水平下降假阳性有关，2例与未找到腺瘤有关。在双侧组的33例患者中，对侧手术探查在11例中完全是由外科医生选择的。在其他22例患者中，除了3例失败外，7例有4个腺体增生，4例有双腺瘤，6例iPTH水平结果假阴性，iPTH水平下降小于50%。
总体而言，72例患者中有48例（67%）至54例（75%）仅通过单侧手术探查即可治愈。
