Noltes Milou E, Coester Annemieke M, van der Horst-Schrivers Anouk N A, Dorgelo Bart, Jansen Liesbeth, Noordzij Walter, Lemstra Clara, Brouwers Adrienne H, Kruijff Schelto
Department of Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30001, Groningen, The Netherlands.
Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Langenbecks Arch Surg. 2017 Nov;402(7):1109-1117. doi: 10.1007/s00423-017-1549-x. Epub 2017 Jan 14.
Minimally invasive parathyroidectomy (MIP) is the recommended treatment in primary hyperparathyroidism (pHPT) for which accurate preoperative localization is essential. The current imaging standard consists of cervical ultrasonography (cUS) and MIBI-SPECT/CT. C-MET PET/CT has a higher resolution than MIBI-SPECT/CT. The aim of this study was to determine the diagnostic performance of C-MET PET/CT after initial inconclusive or negative localization.
We performed a retrospective single center cohort study of patients with pHPT undergoing parathyroid surgery after prior negative imaging and later localization by means of C-MET PET/CT between 2006 and 2014. Preoperative localization by C-MET PET/CT was compared with later surgical localization, intraoperative quick PTH (IOPTH), duration of surgery, histopathology, and follow-up data. Also, differences in duration of surgery between the groups with and without correct preoperative localization were analyzed.
In 18/28 included patients a positive C-MET-PET/CT result corresponded to the surgical localized adenoma (64%). In 3/28 patients imaging was false positive and no adenoma was found. In 7/28 patients imaging was false negative at the side of the surgically identified adenoma. Sensitivity of C-MET PET/CT was 72% (18/25). Duration of surgery of correctly localized patients was significantly shorter compared to falsely negative localized patients (p = 0.045).
In an intention to treat C-MET-PET/CT correctly localized the parathyroid adenoma in 18/28 (64%) patients, after previous negative imaging. A preoperatively correct localized adenoma leads to a more focused surgical approach (MIP) potentially reducing duration of surgery and potentially healthcare costs.
微创甲状旁腺切除术（MIP）是原发性甲状旁腺功能亢进症（pHPT）的推荐治疗方法，准确的术前定位至关重要。目前的成像标准包括颈部超声检查（cUS）和MIBI-SPECT/CT。C-MET PET/CT的分辨率高于MIBI-SPECT/CT。本研究的目的是确定初始定位不确定或阴性后C-MET PET/CT的诊断性能。
我们对2006年至2014年间接受甲状旁腺手术的pHPT患者进行了一项回顾性单中心队列研究，这些患者之前的影像学检查为阴性，随后通过C-MET PET/CT进行定位。将C-MET PET/CT的术前定位与后续手术定位、术中快速甲状旁腺激素（IOPTH）、手术时间、组织病理学和随访数据进行比较。此外，分析术前定位正确和不正确的两组患者手术时间的差异。
在纳入的28例患者中，18例C-MET-PET/CT结果阳性与手术定位的腺瘤相符（64%）。28例患者中有3例成像为假阳性，未发现腺瘤。28例患者中有7例在手术确定腺瘤的一侧成像为假阴性。C-MET PET/CT的敏感性为72%（18/25）。定位正确的患者的手术时间明显短于定位假阴性的患者（p = 0.045）。
在一项意向性治疗中，C-MET-PET/CT在先前影像学检查为阴性的28例患者中的18例（64%）中正确定位了甲状旁腺腺瘤。术前正确定位的腺瘤可导致更有针对性的手术方法（MIP），可能缩短手术时间并降低医疗成本。
