Formánek Martin, Dedek Vladimír, Koláček Michal, Havel Martin, Zeleník Karol, Komínek Pavel
Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70852 Ostrava, Czech Republic.
Clinic of Nuclear Medicine, University Hospital Ostrava, 17. Listopadu 1790, 70852 Ostrava, Czech Republic.
Diagnostics (Basel). 2021 Apr 9;11(4):677. doi: 10.3390/diagnostics11040677.
: Minimally invasive parathyroidectomy is the preferred treatment for primary hyperparathyroidism. Despite relatively accurate preoperative information, minimally invasive parathyroidectomy can be challenging, especially in the case of small and ectopic adenomas. Radio guidance aids in both in vivo identification and ex vivo confirmation of adenoma. In vivo accuracy is currently not satisfactory. The present study evaluated whether a beneficial effect (increased sensitivity, specificity, accuracy) is obtained with individualised timing of minimally invasive radio-guided parathyroidectomy (MIRGP) using preoperative multi-phase 99mTc-MIBI single photon emission computed tomography (SPECT)/computed tomography (CT). This randomised clinical trial was conducted from May 2016 to January 2020 in a tertiary referral hospital. Adult patients with primary hyperparathyroidism sent for 99mTc-MIBI SPECT/CT were included consecutively and randomly assigned to conventional (dual-phase) SPECT/CT and conventional MIRGP (group I) or multi-phase SPECT/CT and individualised MIRGP (group II). One hundred of 106 eligible patients were included, and 83 patients underwent complete intervention. A total of 47 patients in group I and 35 patients in group II were analysed. Group II had a shorter operating time ( = 0.003). The in vivo sensitivity and accuracy of radio guidance was 85.1% in group I and 100% in group II ( = 0.046), and 90.4% in group I and 100% in group II ( = 0.021), respectively. We found no difference in the in vivo specificity and ex vivo parameters between groups. Individualised timing increased the in vivo sensitivity and accuracy of radio guidance and reduced operating time, as some parathyroid adenomas rapidly wash out the radionuclide.
微创甲状旁腺切除术是原发性甲状旁腺功能亢进的首选治疗方法。尽管术前信息相对准确，但微创甲状旁腺切除术仍具有挑战性，尤其是对于小的和异位腺瘤。放射性引导有助于腺瘤的体内识别和体外确认。目前体内准确性并不令人满意。本研究评估了使用术前多期99mTc-MIBI单光子发射计算机断层扫描（SPECT）/计算机断层扫描（CT）对微创放射性引导甲状旁腺切除术（MIRGP）进行个体化时机选择是否能获得有益效果（提高敏感性、特异性、准确性）。这项随机临床试验于2016年5月至2020年1月在一家三级转诊医院进行。连续纳入因原发性甲状旁腺功能亢进接受99mTc-MIBI SPECT/CT检查的成年患者，并将其随机分为传统（双期）SPECT/CT和传统MIRGP组（I组）或多期SPECT/CT和个体化MIRGP组（II组）。106例符合条件的患者中有100例被纳入，83例患者接受了完整干预。对I组的47例患者和II组的35例患者进行了分析。II组手术时间更短（P = 0.003）。I组放射性引导的体内敏感性和准确性分别为85.1%和90.4%，II组分别为100%（P = 0.046）和100%（P = 0.021）。我们发现两组之间的体内特异性和体外参数没有差异。个体化时机选择提高了放射性引导的体内敏感性和准确性，并缩短了手术时间，因为一些甲状旁腺腺瘤会迅速清除放射性核素。
