Department of Otorhinolaryngology - Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center Houston, Houston, TX 77030, United States of America.
Department of Otolaryngology - Head & Neck Surgery, Emory University School of Medicine, Atlanta, GA 30322, United States of America.
Am J Otolaryngol. 2020 Nov-Dec;41(6):102683. doi: 10.1016/j.amjoto.2020.102683. Epub 2020 Aug 15.
Improved preoperative localization facilitates minimally invasive parathyroidectomy for removal of parathyroid lesions therefore preventing an invasive bilateral neck exploration. As 4D-CT has emerged, its high specificity has helped with preoperative parathyroid lesion localization. A high negative predictive value (NPV) would serve to further confirm parathyroid lesion localization and limit unnecessary surgical exploration. This study's objective was to determine the NPV of preoperative 4D-CT and its facilitation of minimally invasive parathyroidectomy.
A retrospective review was compiled for patients undergoing parathyroidectomy for primary hyperparathyroidism with a preoperative 4D-CT. Included patients were sorted into various groups for comparison: those with 4D-CT localizing to a single lesion, localizing to multiple lesions, and those with nonlocalizing findings; multiple hypercellular parathyroid gland versus single gland findings; extent of surgical exploration; lesion location; and patients with concomitant thyroid nodules. Negative predictive value was calculated and used to quantify the ability for 4D-CT to rule out biochemically significant parathyroid lesions.
In our review of 68 patients: sensitivity was 81.3%, specificity was 95.5%, positive predictive value was 87.1%, and negative predictive value was 93.3%. 86% had a single localizing 4D-CT, 7% had a non-localizing 4D-CT, and 7% had a multiple quadrant localizing 4D-CT. NPV for single and multi-localizing 4D-CT were 96.8% and 88.9%, respectively.
Preoperative 4D-CT has a high negative predictive value (93.3%), suggesting in the majority of cases, a quadrant with no 4D-CT radiographic findings suspicious for parathyroid is unlikely to harbor biochemically significant parathyroid lesions.
改良的术前定位有助于微创甲状旁腺切除术切除甲状旁腺病变，从而避免了侵袭性双侧颈部探查。随着 4D-CT 的出现，其高特异性有助于术前甲状旁腺病变定位。高阴性预测值（NPV）将有助于进一步确认甲状旁腺病变的定位，并限制不必要的手术探查。本研究的目的是确定术前 4D-CT 的 NPV 及其对微创甲状旁腺切除术的促进作用。
对接受原发性甲状旁腺功能亢进症甲状旁腺切除术的患者进行了回顾性研究，术前均行 4D-CT 检查。纳入的患者被分为不同的组进行比较：4D-CT 定位到单个病变、多个病变，以及无定位发现的患者；多发性高细胞甲状旁腺与单个腺体发现；手术探查的范围；病变位置；以及伴有甲状腺结节的患者。计算了阴性预测值，并用于量化 4D-CT 排除生化显著甲状旁腺病变的能力。
在我们对 68 例患者的回顾中：敏感性为 81.3%，特异性为 95.5%，阳性预测值为 87.1%，阴性预测值为 93.3%。86%的患者有一个单一的定位 4D-CT，7%的患者有一个非定位 4D-CT，7%的患者有一个多象限定位 4D-CT。单定位和多定位 4D-CT 的 NPV 分别为 96.8%和 88.9%。
术前 4D-CT 的阴性预测值（93.3%）较高，提示在大多数情况下，4D-CT 无放射性发现可疑甲状旁腺的象限不太可能存在生化显著的甲状旁腺病变。
