Yalon T, Neymark M, Rottenberg A, Appelbaum L, Assaf D, Kluger Y, Mazeh H, Mekel M
Department of General and oncologic Surgery - Surgery C, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat Gan, Israel.
Rambam-Health Care Campus, Haifa, Israel.
World J Surg. 2021 Jul;45(7):2148-2154. doi: 10.1007/s00268-021-06066-8. Epub 2021 Mar 18.
Neck ultrasound (US) and Technetium-99 m Sestamibi (MIBI) scan are the most commonly used imaging studies for preoperative localization of parathyroid adenomas. The aim of this study was to determine the added value of MIBI scan and its effect on the operative plan via a hypothetical model where a stepwise approach is conducted and MIBI is considered only after the ultrasound is evaluated.
Patients who underwent parathyroidectomy for primary hyperparathyroidism (PHPT) between 2012 and 2019 at two tertiary centers were included. Data collected included demographic data, preoperative workup, operative findings and follow-up. The added value of MIBI scans was determined for patients with positive ultrasound.
A total of 513 patients with positive US result and a MIBI scan were included. If a stepwise approach was conducted then MIBI scan would not change the operative plan in 492 (95.9%). Among the remaining 21 patients, MIBI scan would correctly change the ultrasound-based operative plan in only 12 (2.3%) patients, while incorrectly change the plan in 9 (1.8%), resulting in unnecessary exploration of the contralateral side. In patients with sonographic appearance of a parathyroid gland larger than 1.2 cm, MIBI scan would correctly change the operative plan in only 1 of the 287 (0.35%) patients.
Our study suggests that the routine use of MIBI scans may have limited added value in patients with PHPT and a positive neck ultrasound, especially in those with adenoma size larger than 1.2 cm. Positive ultrasound alone may be sufficient for the preoperative localization of parathyroid disease.
颈部超声（US）和锝-99m 甲氧基异丁基异腈（MIBI）扫描是甲状旁腺腺瘤术前定位最常用的影像学检查。本研究的目的是通过一个逐步进行的假设模型来确定 MIBI 扫描的附加价值及其对手术方案的影响，该模型中仅在评估超声后才考虑 MIBI。
纳入 2012 年至 2019 年在两个三级中心因原发性甲状旁腺功能亢进症（PHPT）接受甲状旁腺切除术的患者。收集的数据包括人口统计学数据、术前检查、手术结果和随访情况。对超声检查阳性的患者确定 MIBI 扫描的附加价值。
共纳入 513 例超声检查结果阳性且进行了 MIBI 扫描的患者。如果采用逐步方法，那么 MIBI 扫描在 492 例（95.9%）患者中不会改变手术方案。在其余 21 例患者中，MIBI 扫描仅在 12 例（2.3%）患者中正确改变了基于超声的手术方案，而在 9 例（1.8%）患者中错误地改变了方案，导致对侧不必要的探查。在甲状旁腺超声表现大于 1.2 cm 的患者中，MIBI 扫描仅在 287 例（0.35%）患者中的 1 例中正确改变了手术方案。
我们的研究表明，对于 PHPT 且颈部超声检查阳性的患者，常规使用 MIBI 扫描可能附加价值有限，尤其是对于腺瘤大小大于 1.2 cm 的患者。仅超声检查阳性可能足以进行甲状旁腺疾病的术前定位。
