Serradilla-Martín Mario, Palomares-Cano Ana, Cantalejo-Díaz Miguel, Mogollón-González Mónica, Brea-Gómez Esther, Muñoz-Pérez Nuria Victoria, Arcelus-Martínez Juan Ignacio, Villar-Del-Moral Jesús María
Instituto de Investigación Sanitaria Aragón, Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain.
Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain.
Gland Surg. 2021 Mar;10(3):861-869. doi: 10.21037/gs-20-857.
Focused parathyroidectomy is a safe technique for the treatment of primary hyperparathyroidism. The CaPTHUS score and the Wisconsin index are preoperative diagnostic tools designed to distinguish between single- and multigland disease. The aim of the study is to evaluate the usefulness of these models for predicting multiglandular disease in a European population.
Retrospective review of a database of patients operated upon for primary hyperparathyroidism at a referral center. The sensitivity, specificity, positive and negative predictive values, and reliability of both scores for the prediction of multiglandular disease, were calculated. Receiver operating characteristic (ROC) curves were constructed to assess the sensitivity and specificity of CaPTHUS score and Wisconsin Index for predicting single-gland disease. A level of P<0.05 was accepted as significant.
Two hundred and eighty-one patients who underwent successful surgery from January 2001 to December 2018 were included. Single-gland disease was detected in 92.5%, and 73.7% had a CaPTHUS score of ≥3. The sensitivity, specificity, positive and negative predictive values of this model for predicting single-gland disease with a score of ≥3 were 76.9%, 66.7%, 96.6%, and 18.9% respectively. The area under the curve value of the CaPTHUS score for predicting single-gland disease was 0.74. A Wisconsin Index >2,000 and an excised gland weight above one gram presented a positive predictive value for single-gland disease of 92.5%.
Despite the good performance of both scales, the established cut-off points did not definitively rule out parathyroid multiglandular disease in our population. In cases with a minimal suspicion of this condition, additional intraoperative techniques must be used, or bilateral neck explorations should be performed.
聚焦甲状旁腺切除术是治疗原发性甲状旁腺功能亢进的一种安全技术。CaPTHUS评分和威斯康星指数是术前诊断工具，旨在区分单腺体疾病和多腺体疾病。本研究的目的是评估这些模型在欧洲人群中预测多腺体疾病的有效性。
对一家转诊中心接受原发性甲状旁腺功能亢进手术的患者数据库进行回顾性分析。计算了两种评分预测多腺体疾病的敏感性、特异性、阳性和阴性预测值以及可靠性。构建受试者操作特征（ROC）曲线以评估CaPTHUS评分和威斯康星指数预测单腺体疾病的敏感性和特异性。P<0.05被认为具有统计学意义。
纳入了2001年1月至2018年12月期间成功接受手术的281例患者。92.5%检测为单腺体疾病，73.7%的CaPTHUS评分为≥3。该模型预测评分≥3的单腺体疾病的敏感性、特异性、阳性和阴性预测值分别为76.9%、66.7%、96.6%和18.9%。CaPTHUS评分预测单腺体疾病的曲线下面积值为0.74。威斯康星指数>2000且切除腺体重量超过1克时，单腺体疾病的阳性预测值为92.5%。
尽管两种量表表现良好，但既定的截断点并不能明确排除我们人群中的甲状旁腺多腺体疾病。对于对此情况有最小怀疑的病例，必须使用额外的术中技术，或进行双侧颈部探查。
