Payne Sakeena J, Smucker Joanne E, Bruno Michael A, Winner Louis S, Saunders Brian D, Goldenberg David
Division of Otolaryngology Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
Department of Radiology, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
Am J Otolaryngol. 2015 Mar-Apr;36(2):217-22. doi: 10.1016/j.amjoto.2014.10.036. Epub 2014 Nov 6.
Patients with primary hyperparathyroidism routinely undergo preoperative imaging to localize the abnormal gland to facilitate a guided parathyroidectomy. These techniques include neck ultrasound (US), dual phase planar technetium-99m ((99m)TC) sestamibi (MIBI) scans, single photon emission computed tomography (SPECT), combined SPECT/CT, and four dimensional CT scans (4D CT). Despite appropriate preoperative imaging, non-localization of abnormal glands does occur. This study aims to determine whether non-localization is the result of radiologic interpretive error or a representation of a subset of truly non-localizing parathyroid adenomas.
A retrospective study was performed; two senior radiologists reinterpreted the preoperative imaging (US and MIBI scans) of 30 patients with initially non-localizing studies. All patients underwent parathyroidectomy for primary hyperparathyroidism at a tertiary referral center. Both radiologists were blinded to the scores of his colleague. The results were compared for inter-reader reliability using Cohen's kappa test.
Twenty-nine of thirty nuclear studies were found to be negative on reinterpretation. The readers agreed in 86.67% of their observations, with a kappa (κ) value of 0.706 (SE=±0.131, 95% confidence interval for κ =0.449-0.962). One of eighteen ultrasounds had positive localizations on reexamination, however, the inter-observer agreement was only 55.6%, with a kappa value of 0.351 (SE=±0.139, and 95% confidence interval for κ =0.080-0.623). Overall, no statistically significant difference in preoperative and retrospective interpretation was found.
This study identifies a subset of parathyroid adenomas that do not localize on preoperative imaging despite sound radiographic evaluation.
原发性甲状旁腺功能亢进患者通常需进行术前影像学检查，以定位异常腺体，便于实施引导下甲状旁腺切除术。这些技术包括颈部超声（US）、双期平面锝-99m（99mTc）甲氧基异丁基异腈（MIBI）扫描、单光子发射计算机断层扫描（SPECT）、SPECT/CT联合检查以及四维CT扫描（4D CT）。尽管进行了适当的术前影像学检查，但异常腺体仍可能无法定位。本研究旨在确定无法定位是放射学解释错误的结果，还是真正无法定位的甲状旁腺腺瘤子集的表现。
进行了一项回顾性研究；两位资深放射科医生对30例最初检查未定位的患者的术前影像学检查（US和MIBI扫描）进行重新解读。所有患者均在三级转诊中心因原发性甲状旁腺功能亢进接受了甲状旁腺切除术。两位放射科医生均对其同事的评分不知情。使用Cohen's kappa检验比较结果以评估阅片者间的可靠性。
重新解读时发现30例核素检查中有29例为阴性。阅片者在86.67%的观察结果上达成一致，kappa（κ）值为0.706（标准误=±0.131，κ的95%置信区间为0.449 - 0.962）。18例超声检查中有1例在复查时有阳性定位，但观察者间一致性仅为55.6%，kappa值为0.351（标准误=±0.139，κ的95%置信区间为0.080 - 0.623）。总体而言，术前解读与回顾性解读之间未发现统计学上的显著差异。
本研究确定了一部分甲状旁腺腺瘤，尽管进行了合理的影像学评估，但在术前影像学检查中仍无法定位。
