Wang Tracy S, Roman Sanziana A, Cox Heather, Air Mamie, Sosa Julie Ann
Department of Surgery, Division of General Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
J Surg Res. 2009 Jun 15;154(2):317-23. doi: 10.1016/j.jss.2008.06.013. Epub 2008 Jul 9.
Thyroid nodules are found in 12-52% of patients with primary hyperparathyroidism (pHPT). With the increasing use of minimally invasive parathyroidectomy (MIP), there is no standard approach for the management of incidental thyroid nodules in pHPT patients.
A survey was conducted of the American Association of Endocrine Surgeons. Information was obtained regarding parathyroidectomy practice patterns, including surgical technique, preoperative localization procedures, and algorithms used in the diagnosis/treatment of incidental thyroid nodules.
The survey response rate was 74%. Sixty-seven percent were high-volume parathyroid surgeons (>5/mo); the majority performed MIP. High-volume surgeons were more likely to use Sestamibi/single photon emitted computed tomography for preoperative localization (40% versus 24%; P = 0.011) and to disregard incidentally discovered thyroid nodules <1 cm (41% versus 22%; P = 0.023). They were less likely to evaluate nodules discovered intraoperatively by frozen section (28% versus 41%; P = 0.081), fine-needle aspiration (13% versus 24%; P = 0.078), or thyroidectomy (24% versus 40%; P = 0.03). Surgeons performing open parathyroidectomy were more likely than those who use MIP to biopsy nodules intraoperatively (32% versus 20%; P < 0.05) and perform simultaneous thyroidectomy (30% versus 10%; P < 0.001).
Experienced endocrine surgeons disagree about the optimal management of incidental thyroid nodules encountered during parathyroidectomy. Our data suggest that high-volume parathyroid surgeons are less aggressive in their evaluation of thyroid pathology in patients with pHPT. Variation in practice among this experienced group implies even greater variation in the broader surgical community, and in the quality and cost of care for patients with pHPT.
在原发性甲状旁腺功能亢进症（pHPT）患者中，甲状腺结节的发现率为12% - 52%。随着微创甲状旁腺切除术（MIP）的使用增加，对于pHPT患者中偶然发现的甲状腺结节，尚无标准的处理方法。
对美国内分泌外科医师协会进行了一项调查。获取了有关甲状旁腺切除术的实践模式的信息，包括手术技术、术前定位程序以及用于诊断/治疗偶然发现的甲状腺结节的算法。
调查回复率为74%。67%为高手术量的甲状旁腺外科医生（每月>5例）；大多数人进行MIP。高手术量的外科医生更有可能使用锝[99mTc]甲氧基异丁基异腈/单光子发射计算机断层扫描进行术前定位（40%对24%；P = 0.011），并忽略偶然发现的直径<1 cm的甲状腺结节（41%对22%；P = 0.023）。他们对术中通过冰冻切片（28%对41%；P = 0.081）、细针穿刺抽吸（13%对24%；P = 0.078）或甲状腺切除术（24%对40%；P = 0.03）发现的结节进行评估的可能性较小。进行开放性甲状旁腺切除术的外科医生比使用MIP的外科医生更有可能在术中对结节进行活检（32%对20%；P < 0.05）并同时进行甲状腺切除术（30%对10%；P < 0.001）。
经验丰富的内分泌外科医生对于甲状旁腺切除术中偶然遇到的甲状腺结节的最佳处理方法存在分歧。我们的数据表明，高手术量的甲状旁腺外科医生对pHPT患者甲状腺病变的评估不太积极。这一经验丰富的群体在实践中的差异意味着在更广泛的外科领域以及pHPT患者的护理质量和成本方面存在更大的差异。
