在进行原发性甲状旁腺功能亢进的甲氧基异丁基异腈扫描时偶然发现的甲状腺结节的管理。
Management of thyroid nodules incidentally discovered on MIBI scanning for primary hyperparathyroidism.
作者信息
Greilsamer Tristan, Blanchard Claire, Christou Niki, Drui Delphine, Ansquer Catherine, Le Bras Maelle, Cariou Bertrand, Caillard Cécile, Mourrain-Langlois Emmanuelle, Delemazure Anne Sophie, Mathonnet Muriel, Kraeber-Bodéré Françoise, Mirallié Eric
机构信息
Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalier Universitaire (CHU) Nantes-Hôtel Dieu, Place Alexis Ricordeau, 44093, Nantes, France.
出版信息
Langenbecks Arch Surg. 2015 Apr;400(3):313-8. doi: 10.1007/s00423-015-1286-y. Epub 2015 Feb 20.
INTRODUCTION
Parathyroid sestamibi scan is routinely performed before parathyroid surgery. A large number of thyroid cancers take up 99mTc-sestamibi (MIBI). Since 2001, thyroid nodules discovered on sestamibi, nodules >2 cm, and/or with suspicious criteria were resected. The aim of this study was to evaluate the results of this policy.
METHODS
All patients operated on for hyperparathyroidism, with a MIBI and cervical ultrasonography (US) with a thyroid resection for nodule, were retrospectively included.
RESULTS
From 2001 to 2013, 685 patients were operated on for hyperparathyroidism. Some 137 (85 % females) had both preoperative MIBI and cervical US and a thyroid resection. The mean age was 63.2 ± 12.8 years. Sixty-three patients had a total thyroidectomy and 74 a lobectomy. Thirty-six patients had a thyroid cancer. The median size of cancers was 6.5 mm (0.3-22 mm), and 23 (16.7 %) patients had microcarcinoma. Among the 137 patients, 44 (32 %) had a MIBI+ nodule including 22 cancers. Sixty-one percent of malignant nodules were MIBI+ (22/36). The median size of MIBI+ cancers was 15 mm (9-22 mm) versus 2 mm (0.3-17 mm) for MIBI- cancers (p = 0.03). Twenty-two percent of benign nodules were MIBI+ (22/101). Finally, the sensitivity, specificity, positive predictive value, and negative predictive value of MIBI were 61, 78, 50, and 85 %, respectively.
CONCLUSION
Thyroid nodules incidentally discovered on MIBI in hyperparathyroidism patients should be resected.
引言
甲状旁腺99m锝-甲氧基异丁基异腈（MIBI）扫描通常在甲状旁腺手术前进行。大量甲状腺癌会摄取99mTc-MIBI（MIBI）。自2001年以来，在MIBI检查中发现的甲状腺结节、直径大于2 cm的结节和/或具有可疑标准的结节均被切除。本研究的目的是评估这一策略的结果。
方法
回顾性纳入所有因甲状旁腺功能亢进接受手术、进行了MIBI检查和颈部超声（US）检查并因结节行甲状腺切除术的患者。
结果
2001年至2013年，685例患者因甲状旁腺功能亢进接受手术。其中约137例（85%为女性）术前行MIBI检查、颈部超声检查并进行了甲状腺切除术。平均年龄为63.2±12.8岁。63例患者行甲状腺全切术，74例患者行甲状腺叶切除术。36例患者患有甲状腺癌。癌灶的中位大小为6.5 mm（0.3 - 22 mm），23例（16.7%）患者为微小癌。在这137例患者中，44例（32%）有MIBI阳性结节，其中包括22例癌灶。61%的恶性结节为MIBI阳性（22/36）。MIBI阳性癌灶的中位大小为15 mm（9 - 22 mm），而MIBI阴性癌灶的中位大小为2 mm（0.3 - 17 mm）（p = 0.03）。22%的良性结节为MIBI阳性（22/101）。最后，MIBI的敏感性、特异性、阳性预测值和阴性预测值分别为61%、78%、50%和85%。
结论
甲状旁腺功能亢进患者在MIBI检查中偶然发现的甲状腺结节应予以切除。
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